University of California • Berkeley
Regional Oral History Office University of California
The Bancroft Library Berkeley, California
University History Series
School of Public Health Oral Histories
Henrik Blum, M.D., M.P.H.
EQUITY FOR THE PUBLIC'S HEALTH: CONTRA COSTA HEALTH OFFICER;
PROFESSOR, UC SCHOOL OF PUBLIC HEALTH; WHO FIELDWORKER
With an Introduction by
Dr. William C. Reeves
Interviews Conducted by
Caroline Crawford
in 1997
Copyright © 1999 by The Regents of the University of California
Since 1954 the Regional Oral History Office has been interviewing leading
participants in or well-placed witnesses to major events in the development of
Northern California, the West, and the Nation. Oral history is a method of
collecting historical information through tape-recorded interviews between a
narrator with firsthand knowledge of historically significant events and a well-
informed interviewer, with the goal of preserving substantive additions to the
historical record. The tape recording is transcribed, lightly edited for
continuity and clarity, and reviewed by the interviewee. The corrected
manuscript is indexed, bound with photographs and illustrative materials, and
placed in The Bancroft Library at the University of California, Berkeley, and in
other research collections for scholarly use. Because it is primary material,
oral history is not intended to present the final, verified, or complete
narrative of events. It is a spoken account, offered by the interviewee in
response to questioning, and as such it is reflective, partisan, deeply involved,
and irreplaceable.
************************************
All uses of this manuscript are covered by a legal agreement
between The Regents of the University of California and Henrik Blum
dated May 1, 1997. The manuscript is thereby made available for
research purposes. All literary rights in the manuscript, including
the right to publish, are reserved to The Bancroft Library of the
University of California, Berkeley. No part of the manuscript may
be quoted for publication without the written permission of the
Director of The Bancroft Library of the University of California,
Berkeley.
Requests for permission to quote for publication should be
addressed to the Regional Oral History Office, 486 Library,
University of California, Berkeley 94720, and should include
identification of the specific passages to be quoted, anticipated
use of the passages, and identification of the user. The legal
agreement with Henrik Blum requires that he be notified of the
request and allowed thirty days in which to respond.
It is recommended that this oral history be cited as follows:
Henrik Blum, M.D., M.P.H., "Equity for the
Public's Health: Contra Costa Health
Officer; Professor, UC School of Public
Health; WHO Fieldworker, " an oral history
conducted in 1997 by Caroline Crawford,
Regional Oral History Office, The Bancroft
Library, University of California,
Berkeley, 1999.
Copy no.
Dr. Henrik Blum, Professor of Health Planning and Policy,
UCB, 1984; Chairman of HEALS HMO, Chairman of Alta Bates
Hospital.
Cataloging information
BLUM, Henrik L. (b. 1915) Public health educator
Equity for the Public's Health: Contra Costa Health Officer; Professor. UC
School of Public Health; WHO Fieldworker. 1999, xii, 425 pp.
Growing up on a farm in Napa; UC Berkeley, 1931-1937; UC San Francisco
Medical School, 1942; military service, 1942-1946, US Public Health
Service: venereal disease research projects, faculty position at Johns
Hopkins; Rockefeller Research Fellow, Stanford; M.P.H., Harvard, 1948;
County Health Officer, Contra Costa County, 1950-1966: the multipurpose
healthcare worker, sanitation, mental health, birth control, the Orinda
Vision Study; Professor, School of Public Health, UC Berkeley, 1966-1984:
health planning curriculum, affirmative action, authoring health planning
texts, Joint UCB-UCSF Medical Program; Alta Bates and Herrick Hospitals,
HEALS HMO, thoughts about managed care; international fieldwork with the
World Health Organization in Sri Lanka, Colombia, Chile, 1970-1973; with
the Agency for International Development in Nepal, 1977; health care in
Europe and Australia, American Samoa and Northern Marianas; Fulbright
teaching fellow in Sweden, 1986; teaching health planning in China, 1987;
Over 60 and On Lok health programs.
Introduction by Dr. William C. Reeves, Professor emeritus, UC
Berkeley School of Public Health.
Interviewed by Caroline C. Crawford in 1997 for the School of Public
Health Oral History Series. Regional Oral History Office, The
Bancroft Library, University of California, Berkeley.
ACKNOWLEDGMENTS
The School of Public Health and the Regional Oral History Office, on
behalf of future researchers, wishes to thank the following individuals and
organizations whose contributions made possible this oral history of Henrik
Blum.
Anita Addison
Balan and Gurdeep Arakoni
Katherine Armstrong
Richard Bailey
Willa Baum
Cheryl Belcourt
Joan and Howard Bloom
Sandra and John Boeschen
Patricia and Richard Buffler
Chin Long and Fu Chen Chiang
Joanna Ciaglia
Sylvia De Trinidad
Anne Donnelly
Eleanor Fletcher
FMC Foundation
David and Sylvia Frost
Margaret Hall
Judith Hibbard
Pat and Harry Hosel
Sharron Humenick
Carlessia Hussein
Lucy Johns
Donald and Inez Johnson
Olive Johnson
Kaiser Pennanente
Barry Kaplan
Jane Kenyon
Margo Kerrigan
Kathryn and Niels Kjellund
Joyce and Richard Lashof
Dan Lindheim
Richard and Roselyn Lindheim
Memorial Trust
Susan Lindheim
James Lubben
Merle Lustig
Dextra Baldwin McGonagle
Foundation
George McKray
Donald and Elizabeth Minkler
Meredith Minkler
Patricia Mullen
Ed Nathan
Thomas Novotny
Dorothy Nyswander
Martyann Penberth-Valentine
Janet Perlman
Mary Pittman and David Lindeman
Nancy Presson
Florence and Paul Raskin
William and Mary Jane Reeves
Joseph and Nancy Restuccia
Frances Saunders
George and Linda Sensabaugh
Sandra Shewry
Takeo Shirasawa
Ralph Silber
Rosalind Singer
Harvey Smith
Shoshanna Sofaer
Lucia and Peter Sommers
Sandra Stein-Starr
Mary Stevens
S. Leonard Syme
David Taylor
Cheryl Wyborny
Ruth Young
TABLE OF CONTENTS- -Henrik Blum
PREFACE by Patricia A. Buffler i
INTRODUCTION by William C. Reeves v
INTERVIEW HISTORY xi
BIOGRAPHICAL INFORMATION xiii
I FAMILY HISTORY, CHILDHOOD AND EDUCATION: 1915-1934 1
Caveats and Oral History 1
Wartime Experiment Using Human Guinea Pigs 3
Parents and Childhood in Napa 12
The Community in Petaluma and Farming in Coombsville 15
Schooling 23
High School Egalitarianism and Elitism 27
The Depression Years 35
Music Studies and Cultural Exposure 41
II COMING TO UC BERKELEY: UNDERGRADUATE STUDIES, 1931-1937 45
From Engineering to Chemistry 45
Perry R. Stout and Daniel Arnon: Mentors 49
Choosing a Career 54
III UNIVERSITY OF CALIFORNIA MEDICAL SCHOOL: 1938-1942 57
Happy Jack: Starting Medical School and Finding Housing 57
Chauncey Leake and Pharmacology 59
Being a Pain in the Neck in Pathology in Our Second Year 60
Housing During Medical School 62
Obstetrics at San Francisco General 64
Treating the Poor and Thoughts of a Career in Public Health 69
More About Medical School and Student Activism 78
IV SERVING IN THE U.S.P.H.S. IN WORLD WAR II--PART OF THE ARMED
SERVICES: 1942-1946 80
An Internship at the Marine Hospital in San Francisco and a Brief
Stint at a Venereal Disease Hospital in Arkansas 80
A VD Research Project at the Penitentiary in Terre Haute, Indiana 83
Applying to the Regular Corps 89
A Faculty Position at Johns Hopkins University Medical School 90
Assignment to San Diego 101
Going AWOL: Back Surgery at the San Francisco Marine Hospital 107
V RESIDENCY AT STANFORD AND ON TO HARVARD: 1946-1948 110
Treating and Studying Syphilis 110
Harvard University and the School of Public Health 118
A Special Bostonian Family 122
VI SETTLING IN CALIFORNIA- -CONTRA COSTA COUNTY: 1950-1966 126
The California State Health Department: A Year in San Diego, and
on to Contra Costa County 126
Serving as County Health Officer in Contra Costa County 130
Expanding the Budget and the Department: Testing for TB 134
Signing Off on Septic Problems 138
The County Hospital and George Degnan 140
Sanitation Problems and County Restaurants 146
Labor and Industry Politics: Tidewater Oil 156
Growing Wild in Contra Costa: More about Sewers and Other
Amenities 158
A Privately Owned Development; A Municipal Utility District 168
Dealing with the AEC and other Federal and State Watchdog Agencies 171
Anne Leslie: "Office Wife" 172
The Civil Service and Other Frustrations 173
More about the Mental Health Program, and Serving with the
Space Cadets: 1956-1965 176
Being Considered for a Faculty Position at Harvard 181
Co-Authoring a Book about Administration: 1963; A Housing
Project in East St. Louis; Lincoln Hospital in New York 184
Funding for Navajo Projects 187
The Multipurpose Worker and the Rodeo Center: 1964 188
Studying Health Care Systems in Europe on a 1962 WHO Fellowship
and a Later Study of Health Care in Australia 193
Birth Control Programs and Governor Pat Brown 202
Elizabeth Jolly and the Crippled Children's Program 212
Training Peace Corps Volunteers: 1964 215
Other Streams: Creating Air Pollution Control Legislation (1955)
and the John F. Kennedy University (1964); the Orinda Vision
Study (1959) 218
Business Activities in Contra Costa County 233
A House in Berkeley 236
VII MOVING TO BERKELEY: THE UNIVERSITY AND OTHER INVOLVEMENTS:
1966-1984 240
Joining the University of California Faculty and a Campus Revolt 240
Job Offers from Stanford, New York City, and Los Angeles Health 243
A Joint Masters Program: Department of City and Regional Planning
and Health Planning: Collaboration with Nathan Glaser 245
A First Course in Health Planning, 1967, and New Legislation:
The 89th Congress, 1966 248
A 1968 Planning Grant from the USPHS; a Program for Minorities and
Native Americans; Abandoning Our Marvelous Planning Grant 256
Pressure to Publish, Public Administration, and Alex Meiklejohn 267
Building a Planning Faculty 269
Serving on Committees of the Academic Senate 272
Thoughts about Teaching and W.C. Fields 275
American Public Health Association Involvements in the 1960s 277
Advising Governor Reagan--Greed is Great: 1967 280
Planning for Health and Expanding Health Care Horizons. Two
Textbooks: 1974, 1976 " 282
The Hospital World: Alta Bates and Herrick Hospitals and HEALS 290
VIII INTERNATIONAL FIELD SERVICE: 1969-1981 307
Dr. Hilleboe and the World Health Organization 307
Working with WHO in Sri Lanka: 1970 310
WHO and a Planning Handbook 324
Assignments in South America with the Pan American Health
Organization 325
A USAID Project in Nepal 333
Planning in Color Country, Utah 340
A Keynote Speech on Prevention in Paris: 1982, Courtesy of the
Drug Companies; A Contrast, Consulting for MDI 344
Fieldwork in Three Pacific Islands and Yemen, 1980 347
A Fulbright Award in Sweden (1986) and Thoughts about Fieldwork 354
Teaching Health Planning in Chengdu, China, 1987 361
IX THE 1980s AND 1990s 363
Reviving the Joint Medical Program 363
Ronnie London and Maggie Hall 368
The Over 60 and On Lok Programs and Managed Care 371
A Hypothetical Health Care Study 381
Awards and Afterthoughts 385
Reflections on a University Career 391
A Sweet Finale 394
TAPE GUIDE 395
SAMPLE EDITED AND INSERTED PAGES 398
APPENDIX
A Henrik Blum Curriculum Vitae, 1994 400
B University of California Oral History Series List 408
INDEX 420
PREFACE by Patricia A. Buffler
It is a pleasure to introduce the University of California School
of Public Health Oral Histories which highlights contributions of Public
Health faculty members to the health and well being of populations in
California and worldwide through their teaching, research, and other
scholarly activities.
The idea of an oral history series in Public Health was proposed
in 1993 with the successful completion of the oral history of William
Reeves, the fourth public health faculty member to participate in the
Regional Oral History Office program of The Bancroft Library.
The foundations of the School of Public Health date back to the
beginning of the twentieth century when the University of California and
Stanford University initially collaborated on a graduate curriculum in
public health. Subsequently in response to the urgent need for more
public health professionals in the Western United States, the 1943
California State Legislature and Governor Earl Warren enacted into law a
bill mandating the creation of the first school of public health west of
the Mississippi River. The school was established at the University of
California, Berkeley, where public health had its origins more than two
decades earlier with the creation in 1917 of a Program in Hygiene in the
Department of Zoology.
Since its founding, the UC Berkeley School of Public Health has
become one of the world's preeminent centers dedicated to the promotion
and protection of the health of human populations, and noted for the
excellence of its programs in teaching, research, and service. These
programs, grounded in an understanding of theory and mechanisms of the
basic sciences, are integrated through a focus on communities that reach
from Berkeley's surrounding neighborhoods to settings around the world.
For example, encephalitis was largely suppressed because of the
work of Professors William Reeves and James Hardy; Dean Charles E.
Smith's pioneering studies of coccidioidomycosis (Valley Fever) resulted
in the development of a vaccine for the disease; and Professor Dorothy
Bird Nyswander's contributions in public health education and
administration are renowned both nationally and internationally in the
areas of family planning, school health, and prevention and eradication
of malaria.
The tradition continues with teaching and research in such areas
as AIDS, cancer, violence, infant mortality, the toxicity of industrial
waste, tobacco-related diseases, human genetics, health care financing
and delivery systems, reproductive health, infectious diseases, and the
impact of media on behavior.
ii
Today, the School of Public Health at Berkeley enrolls
approximately 475 students annually-- 13 percent from other countries and
approximately 25 percent from diverse minority cultures within the
United States.
The School of Public Health faculty is drawn from a variety of
disciplines, including epidemiology, biology, economics, political
science, anthropology, and chemistry, and from professional fields such
as medicine, engineering, business, and social work. Faculty
distinctions include six American Association for the Advancement of
Science Fellows, three Fulbright Scholars, five members of the National
Academy of Sciences, Institute of Medicine; and advisory appointments to
the Centers for Disease Control, the National Institutes of Health, and
the World Health Organization.
Over the past fifty-five years, Berkeley has consistently been on
the cutting edge with innovative programs including:
-The Health and Medical Sciences UCB/UCSF Joint Medical Program,
which was established twenty-five years ago as an alternative to
the traditional four-year medical school located in a medical
center complex. Medical students at Berkeley not only complete
their preclinical training on the Berkeley campus but are
introduced to medical care in a variety of community settings and,
by committing an additional year, also earn a Master of Science
degree ;
-A long standing progressive teaching program in Maternal and
Child Health, which since 1955 has prepared over 900 specialists
in Maternal and Child Health with a strong research and
professional practice orientation;
-A nationally recognized and model field training program for
public health students, which ensures an academically supervised
internship for all professional students seeking to earn a Master
of Public Health degree;
-The American Indian Graduate Program, which has trained about 200
Indian/Alaskan natives from over eighty tribes since its inception
in 1971;
-Centers of excellence in research and service, including the
Prevention Research Center for Family and Community Health, the
Center for Health Management Studies, the Northern California
Center for Occupational and Environmental Health, and the Center
for Children and the Environment;
-A mission statement which incorporates a commitment to human
rights and multicultural perspectives, the first school of public
health to do so; and
-A sponsored research and research training portfolio which today
exceeds $25 million and amounts to more than $500,000 per ladder
rank faculty member, ranking the school among the most productive
and extramurally well-funded units on the Berkeley campus.
Ill
The oral history of Professor Henrik Blum is the seventh in the
Public Health Series following volumes by six early faculty members:
Karl F. Meyer and his research on zoonotic diseases of public health
significance, Jessie Bierman and her research on maternal and child
health, Sanford Elberg and his research on brucellosis, William Reeves
and his studies of arthropod-borne encephalitides, Dorothy Nyswander and
her international work in health education, and, still in process,
Warren Winkelstein who was one of several pioneering investigators in
the San Francisco AIDS epidemic in the 1980s. The oral history of
Henrik Blum represents a unique contribution to this series with its
emphasis on health planning, community development, and humanism in
medical and public health education.
During its distinguished history the school has undergone
successfully several transitions. The evolution of public health
education and the need for these transitions are well illustrated in the
careers of faculty who provided leadership during these critical times.
The leadership and vision of the public health faculty is evident
in all of these oral histories. These true pioneers anticipate not just
the health problems consequent with certain conditions, but new
solutions to these problems. The lives and careers of these faculty
members provide a rich account of the history of public health and
public health education in California.
Patricia A. Buffler
Dean Emerita and Professor of Public
Health Epidemiology
February 1999
School of Public Health
University of California
Berkeley, California
ii
Today, the School of Public Health at Berkeley enrolls
approximately 475 students annually-- 13 percent from other countries and
approximately 25 percent from diverse minority cultures within the
United States.
The School of Public Health faculty is drawn from a variety of
disciplines, including epidemiology, biology, economics, political
science, anthropology, and chemistry, and from professional fields such
as medicine, engineering, business, and social work. Faculty
distinctions include six American Association for the Advancement of
Science Fellows, three Fulbright Scholars, five members of the National
Academy of Sciences, Institute of Medicine; and advisory appointments to
the Centers for Disease Control, the National Institutes of Health, and
the World Health Organization.
Over the past fifty-five years, Berkeley has consistently been on
the cutting edge with innovative programs including:
-The Health and Medical Sciences UCB/UCSF Joint Medical Program,
which was established twenty-five years ago as an alternative to
the traditional four-year medical school located in a medical
center complex. Medical students at Berkeley not only complete
their preclinical training on the Berkeley campus but are
introduced to medical care in a variety of community settings and,
by committing an additional year, also earn a Master of Science
degree;
-A long standing progressive teaching program in Maternal and
Child Health, which since 1955 has prepared over 900 specialists
in Maternal and Child Health with a strong research and
professional practice orientation;
-A nationally recognized and model field training program for
public health students, which ensures an academically supervised
internship for all professional students seeking to earn a Master
of Public Health degree;
-The American Indian Graduate Program, which has trained about 200
Indian/Alaskan natives from over eighty tribes since its inception
in 1971;
-Centers of excellence in research and service, including the
Prevention Research Center for Family and Community Health, the
Center for Health Management Studies, the Northern California
Center for Occupational and Environmental Health, and the Center
for Children and the Environment;
-A mission statement which incorporates a commitment to human
rights and multicultural perspectives, the first school of public
health to do so; and
-A sponsored research and research training portfolio which today
exceeds $25 million and amounts to more than $500,000 per ladder
rank faculty member, ranking the school among the most productive
and extramurally well-funded units on the Berkeley campus.
Ill
The oral history of Professor Henrik Blum is the seventh in the
Public Health Series following volumes by six early faculty members:
Karl F. Meyer and his research on zoonotic diseases of public health
significance, Jessie Bierman and her research on maternal and child
health, Sanford Elberg and his research on brucellosis, William Reeves
and his studies of arthropod-borne encephalitides, Dorothy Nyswander and
her international work in health education, and, still in process,
Warren Winkelstein who was one of several pioneering investigators in
the San Francisco AIDS epidemic in the 1980s. The oral history of
Henrik Blum represents a unique contribution to this series with its
emphasis on health planning, community development, and humanism in
medical and public health education.
During its distinguished history the school has undergone
successfully several transitions. The evolution of public health
education and the need for these transitions are well illustrated in the
careers of faculty who provided leadership during these critical times.
The leadership and vision of the public health faculty is evident
in all of these oral histories. These true pioneers anticipate not just
the health problems consequent with certain conditions, but new
solutions to these problems. The lives and careers of these faculty
members provide a rich account of the history of public health and
public health education in California.
Patricia A. Buffler
Dean Emerita and Professor of Public
Health Epidemiology
February 1999
School of Public Health
University of California
Berkeley, California
iv
February 1999
University History Series
School of Public Health Oral Histories
Jessie Bierman, M.D. (1900-1996)
Maternal and Child Health in Montana, California,
the U.S. Children's Bureau, and WHO. 1926-1967,
1987.
Henrik L. Blum, M.D. and M.P.H. (b. 1915)
Equity for the Public's Health: Contra Costa
Health Officer; Professor. UC School of Public
Health; WHO Fieldworker. 1999.
Sanford S. Elberg, Ph.D. (b. 1913)
Graduate Education and Microbiology at the
University of California. Berkeley, 1930-1989,
1990.
Karl F. Meyer, Dr. Med. Vet., Ph.D. (1884-1974)
Medical Research and Public Health.
1976
Dorothy B. Nyswander, Ph.D. (1894-1998)
Professor and Activist for Public Health
Education in the Americas and Asia. 1994
William C. Reeves, Ph.D. (b. 1916)
Arbovirologist and Professor. UC Berkeley
School of Public Health. 1993.
Pediatrician;
professor;
public health
administrator
Health planner,
administrator,
professor
Microbiologist ;
professor
and administrator
Epidemiologist ;
Director, Hooper
Foundation, UCSF
Public health
professor and
educator
Epidemiologist ;
Professor, UC Berkeley
School of Public Health
INTRODUCTION by William C. Reeves
When I was asked to prepare an introduction to Henrik Blum's oral
history, I wondered if our frequent but usually casual associations for
forty-plus years would be an adequate base of operations. Then, I
decided: What the hell, if The Bancroft Library staff and Henrik want me
to do it, I'll do it. It should be fun and it will reload my memory
bank. I can play the role of a fan on the sidelines watching a star
play the health planning game, a star who over his career has improved
the health of people throughout the world. This was not an easy task to
take on, but one worth doing. I was given an opportunity to read drafts
of several chapters of Henrik 's opus and as I expected, I found that he
has called a spade a spade, is fair in his judgments about the character
of other players in the game, and has given damnation or praise as it
was earned.
Henrik Blum's early life was spent on a farm in the Napa Valley of
California. Many of his views still reflect the imprint left on him
from growing up during the economic Depression of the 1930s. He was
exposed to high standards of honesty, and learned how to use direct
approaches to solve problems. He also discovered the need to evaluate
the character and competence of associates and not to yield to the
ethnic prejudices and other biases that still prevail in most
communities almost seventy years later. As an undergraduate at Berkeley
he was fortunate enough to meet and wed Marian H. Ehrich. They have
spent almost sixty years together as loving partners, sharing career and
home changes, worldwide travels, and a deep love of music and the arts.
Whenever I comment to Henrik on his unusual capacity to judge the
character or competence of people, he tells me he is an amateur compared
to Marian. She has been a remarkable person with whom to share and
enjoy life.
Recruiting Henrik to the faculty of the School of Public Health in
the early 1950s was no big problem. At that time, the epidemiology
faculty was very small. The number of courses was very few and in fact,
some days I was the only instructor present. Henrik was the Health
Officer for Contra Costa County and we asked him to teach an
introductory course in epidemiology which previously had focused largely
on infectious diseases and was required for all public health students.
Only epidemiology majors and a few physicians were exempted because we
assumed they already had some background in epidemiology. They were
placed in a so-called "advanced" course. Dr. Blum was well trained in
medicine and basic epidemiology and, most importantly, was handling
epidemiological problems at the community level every day. We wanted to
bring that experience into the classroom for students who had a wide
range of backgrounds and interests, most of whom would someday be
employed by health agencies. Henrik welcomed the opportunity to meet
VI
with students and share his experiences, and he did not limit the course
to infectious diseases. It was unfortunate, in retrospect, that a
majority of the physicians and all of the epidemiology majors who were
enrolled in the more advanced and theoretical course in epidemiology
were unable to benefit from Henrik's wisdom.
During those early years, Henrik was publishing widely, not only
on epidemiological problems but also to illustrate how such problems
interfaced with community concerns and family needs for health services.
Most local health programs were focused on control of communicable
diseases and usually within a fairly rigid administrative framework.
Henrik published on problems that he had dealt with in Contra Costa
County such as diabetes detection, genetic counseling, school lunch
programs, mental health, vision screening, safety education, and
fluoridation of water. In each case, he focused on recognition of the
community's needs, its resources, and concerns, and whose participation
was essential to the resolution of the problem. Each required a new
approach to planning and organization to identify community concerns and
resources that could resolve the issue.
One landmark venture occurred in 1966 when Henrik and Dr. George
Keranen developed a handbook entitled Control of Chronic Diseases in Man
which was published by the American Public Health Association. This was
to be a companion volume to Control of Communicable Diseases in Man
which was published by the same association and which sat on the desk of
most public health workers. Unfortunately, the chronic disease manual
was not reissued and expanded in future years when such problems became
the primary focus of most public health programs. This visionary
publication foresaw a need and paved a pathway that public health needed
to travel.
At a time in Henrik's tenure as a health officer, his staff became
unionized and he was required to work and bargain with the unions. His
approach to this situation was to join the union himself. You can
imagine the turmoil and consternation of the union officers when they
found out that the person they had to deal with concerning employment by
his agency was a member of their union, could attend their meetings,
vote, et cetera. This innovative approach had a twist of Blum humor
behind it.
When Henrik retired after fifteen years as Health Officer of
Contra Costa County, he had many ideas about the future approaches to
public health problems. Although several agencies were anxious to
recruit him, when Dean Charles Smith offered Henrik an appointment as
Clinical Professor of Public Health at Berkeley in 1966, he decided that
this could provide him a base of operations, an outlet to advance his
interests in health planning, and an opportunity to extend his teaching
in public health administration. The original position did not have the
campus clout or financial security of a tenured position, but when I
vii
became Dean in 1968, I was able to obtain a tenured appointment for
Henrik as Professor of Community Health Planning.
By this time, Henrik had made it clear that health planning had a
separate identity from public health administration, and there was an
opportunity for the Berkeley School of Public Health to become the
national, even international leader in this field, exposing the
students, faculty, and other associates to a new frontier in health.
Henrik presented his new approaches in the publication Public
Administration. A Public Health Viewpoint. He developed dialogues and
collaborative arrangements with campus and outside professionals who
were leaders in aspects of planning from many other fields. At this
time the campus had entered a period of strife and turmoil over the
Vietnam War, free speech, minority needs, et cetera. It was a tough
time to carry out the orderly planning of a new curriculum or major
program which required the joint effort of individuals who might not
only have different concepts of health planning but were on opposite
sides regarding current campus issues. As Dean, I was known as a
conservative and Henrik was considered an activist; hardly likely
"bedmates" for a concerted activity. Nonetheless, we recognized from
the beginning that we could both meet our academic and social objectives
by joining forces to develop health planning as a new field of study. I
decided to give him a relatively free rein to see what he could and
would do. The proposed program stressed recruitment of minority
students into the school and development of affiliations with other
academic departments on campus. It also addressed many community issues
and needs concerning health.
If there was a secret to the development of this new field, it was
first that Henrik had an idea and he obtained a large three-year federal
grant. The grant assured financial support for minority students to
fill nineteen new student admissions he had obtained from the graduate
division, allowed for the appointment of a variety of new non-tenured
faculty and staff from a variety of fields and backgrounds, and provided
resources to bring in eminent visiting speakers from many other fields.
It was a great venture and it succeeded. In his oral history, Henrik
discusses all of this very candidly and with no holds barred on
inclusion of controversy.
One side of Henrik Blum that is sometimes hard to adjust to is his
response when a colleague, student, or outsider asks for advice.
Usually he asks the person to describe the problem, how he got the
information, and how the problem is being approached. If the approach
does not show a good comprehension of the problem at hand and a
receptivity to alternatives, Henrik might tell them a story about a
parallel experience and outcome. If the person still doesn't understand
what is going on or insists there are no alternatives, Henrik may just
relate his version of the "facts of life" in no uncertain terms. This
approach wakes up most people and frequently solves their problems — if
viii
so, they usually thank him and end as good friends, and he never forgets
them. He is one of the few people I know who can give you hell and then
have you thank him for it.
Henrik awakened a wide audience to the breadth of community health
problems. Three of his publications stand out as landmarks in the
emergence of health planning as a field of study and an approach to the
health needs of communities. The first is Public Administration; A
Public Health Viewpoint (1963). The second is Health Planning (1969),
and the third, Planning for Health (1974), devoted 621 pages to a broad
and in-depth coverage of this new field. It quickly became a bible for
health planners. Each of these publications received national and
international acclaim, and what had been conceived for health planning
at a community level in California soon came to the attention of the
World Health Organization. Henrik1 s account of his national and
international experiences are completely fascinating as he describes how
he functioned within each system. In truth it was hard work and
extremely time-consuming. Many of his concepts and objectives were not
understood or were rejected by the people assigned to carry them out,
and getting them implemented in the real world was a challenge which
required worldwide travel. Marian accompanied him on all his adventures
and they made many new friends wherever they went: Geneva, Nepal, Sri
Lanka, Sweden, Denmark, Australia, China, and Canada, to name a few. A
senior faculty member of our school tells me that anywhere he travels in
the world today, he encounters followers of Henrik who are still quoting
his books on health planning, or perhaps remember a visit he and Marian
made and want to send their thanks and regards.
The American Public Health Association paid its respect to Henrik
in 1985 when he was presented its most prestigious award, the Sedgwick
Memorial Medal. The focus of that award was to recognize the
contribution of his health planning concepts to the field of public
health.
The final chapter of Henrik 's oral history might be called an
encore before his third retirement. It is devoted to his experiences
from 1991 to 1994, when six years after retiring as Emeritus Professor
he was recalled to serve as interim chair of the Health and Medical
Sciences program at Berkeley. In this program, students receive three
years of intensive training which covers the first two years of medical
school and also requires completion of a master's degree in Health and
Medical Sciences. This was to be a temporary one-year position while a
new permanent chair was being selected. Instead it turned into a stormy
and difficult task, requiring four years of Henrik 's time. The program
was being assailed by several individuals and groups who wished to
destroy it, but fortunately since Henrik had been involved with the
program since its inception, he believed deeply in its objectives. The
original conception of such a program had come from meetings of a core
of faculty from the School of Public Health and a group of practicing
ix
physicians and hospital staff from the East Bay. Its roots went back to
the 1930s and earlier when students in the University of California, San
Francisco medical school program spent their first academic year on the
Berkeley campus taking basic science courses, which had not yet been
developed in San Francisco. Henrik had been a student in that program
in the 1930s.
Henrik dedicated his time as interim chair to fighting for
survival of the program, recruiting faculty, and broadening and
increasing relationships with campus faculty in other departments. He
opened a "gateway to faculty" on the campus for students to use as
resources for their theses. He personally met with as many student
applicants and new admissions to the program as possible. He had an
"open door" policy for his office and was available for consultation on
any problem. Rather than carrying out formal teaching, he attended
seminars where problems were presented by students and discussed. This
was his ballpark for personal enjoyment. Within the School of Public
Health, Henrik is referred to at times as the "John Wayne" of public
health and medical education. He continues his dedication to correcting
the wrongs of society, fighting for the rights of the downtrodden, and
challenging the "bad acts" of some individuals. If you asked Henrik
about this he would probably smile and say, "And I don't even own a
gun."
When Henrik retired in 1985 to become Emeritus Professor, his
friends and associates paid their respects by establishing the Henrik L.
Blum Award for Distinguished Social Action. The award is given annually
to a graduating student of the school. Each candidate is evaluated for
his or her public health activities that symbolize the spirit of social
justice and democratic action which Dr. Blum has epitomized and which he
implemented in the minds and hearts of students, professors, staff, and
alumni. The selection committee includes representatives of all those
groups. In the past ten years, this award has become the most
prestigious and sought-after recognition by graduating class members.
The recipient gets a standing ovation at commencement and a very nice
plaque. There is no monetary award and none is needed. Recognition is
the award. The award will long stand as a reminder of Henrik1 s
standards and goals.
Another important current event in Henrik 's life occurred on May
22, 1998, when he received the Award for Excellence in Teaching by a
Pre-Clinical Teaching Faculty Member at the commencement exercises of
the School of Medicine at UC San Francisco. This awardee is selected by
the students and not by a faculty committee, and if I know Henrik, this
makes it a very special award for him. Although I will be guilty of
plagiarism, I would like to repeat a statement made at the presentation
of this most recent award: "Dr. Blum has inspired generations of
medical students with his personal example, innovative leadership, and
commitment to promoting the health of communities. His analysis of
forces underlying the politics and sociology of medicine makes students
aware of their own role as physicians in society. When it comes time
for students to write their master's degree theses, he opens important
doors by sharing his many academic and community connections. He
continues to use his wealth of knowledge and experience in medicine and
public health to guide and challenge students in their exploration of
the fundamental issues in health care."
It has been a privilege and valuable lesson for all of us to be
associated with Dr. Henrik Blum and we thank him for sharing his history
with us .
Professor William C. Reeves
School of Public Health
University of California, Berkeley
June 1998
xi
INTERVIEW HISTORY- -Henrik L. Blum
Henrik Blum was an obvious choice for the Regional Oral History
Office's public health series; he has been a giant in the health
planning field for over forty years. Dr. Blum, M.D. and M.P.H., came to
the University of California faculty in 1968 with much more than
theories on his mind. Unlike many of his colleagues, he had headed a
health department (Contra Costa County, 1950-1966) and before that
served the U.S. Public Health Service as part of the armed services
working on a number of venereal disease assignments and research
projects .
He joined the UC faculty at the time when the university was in
great turmoil and quickly showed himself to be an activist. He was one
of few to insist on an open-door policy that persists today well into
his emeritus years. Students remember his health planning courses, the
first in the university's history, as life-changing experiences where
they learned the difference between mere medical care that dealt with
disease and health care that dealt with life.
Dr. Blum's students always came first and they knew it. He could
always be counted on to take up the fight for an individual's rights or
a student cause. When the 1998 UCSF medical school graduates wrote Dr.
Blum that they intended to give him a preclinical teaching award last
May, they cited his brilliance and excellence, his passion and
compassion, his status as "one of the best role models we have
encountered in all our years at UCSF."
Dr. Blum came to the oral history with reservations, wondering if
he would be able or willing to deal with the "down times." During the
seven two-hour sessions in his office on the fifth floor of University
Hall, he proceeded to work through them with utmost candor; the politics
of medical research and academia and his involvements in those arenas,
the injustices of contemporary society.
Through the years he was always where the action was: he
coauthored the original San Francisco Bay Area air pollution control
legislation in 1955, helped create John F. Kennedy University in 1964,
established an early and important HMO called HEALS--now HealthNet--
wrote signal texts in health planning, and managed to consult for WHO,
PAHO, and AID all over the developing world — as late as 1986 he was a
Fulbright teacher in Sweden.
A highlight of the oral history is his documentation of the School
of Public Health, where he was on the faculty for almost two decades.
As a professor of community health planning in 1968 he pioneered the
school's first health policy course and became chairman of the then-new
program in planning and policy and wrote the landmark textbook in the
Xll
field, Planning for Health. Dr. Blum arrived on the scene in 1966, when
the School of Public Health was all but shut down by student unrest, and
from the beginning of his tenure often took unpopular positions. With
no support by fellow faculty, for example, he was able to create
nineteen slots for minority graduate students and initiate successful
recruitment programs for Native Americans.
Dean Patricia Buffler suggested that the Regional Oral History
Office document Dr. Blum's life and work and has written the preface to
the series; we are indebted to her and to Pat Hosel for organizing the
fundraising, and to Dr. William Reeves for his fine introduction to the
volume and for serving on the project's advisory committee. Others on
the committee were Rosalind Singer, Richard Bailey, Joan Bloom, Patricia
Buffler, Lucy Johns, Joyce Lashof, Mike McDonald, George McKray, Theresa
Pipe, Mary Pittman-Lindeman, and Shoshanna Sofaer. Lucy Johns also
provided important perspective as a student of Dr. Blum's in the 1960s.
The seven interview sessions, from January to early May of 1997,
were held in a relaxed atmosphere, with students often greeting Dr. Blum
as they passed the office, and often went over the scheduled two hours.
There were as many review sessions with him, and after he reviewed the
text, Dr. Blum wrote out in longhand substantial additions; these are
indicated by "##" notations in the text and on the tape guide, and
sample edited and inserted pages appear after the text.
In addition, Dr. Blum donated his collected papers to The Bancroft
Library, where they may be viewed by researchers.
Dr. Blum is openly irreverent about many things in the oral
history. The resulting document is candid—describing the downside of
local politics, academia and international helping agencies; on the
upside it documents high incidents of morality of health care, esteemed
colleagues, and the life of an individual who mattered.
The Regional Oral History Office was established in 1954 to
augment through tape-recorded memoirs the Library's materials on the
history of California and the West. Copies of all interviews are
available for research use in The Bancroft Library and in the UCLA
Department of Special Collections. The office is under the direction of
Willa K. Baum, Division Head, and the administrative direction of
Charles B. Faulhaber, James D. Hart Director of The Bancroft Library,
University of California, Berkeley.
Caroline Crawford
Interviewer /Editor
September 1998
Regional Oral History Office
The Bancroft Library
University of California, Berkeley
xiii
Regional Oral History Office University of California
Room 486 The Bancroft Library Berkeley, California 94720
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I FAMILY HISTORY, CHILDHOOD, AND EDUCATION: 1915-1934
[Interview 1: January 23, 1997)
Caveats and Oral History
Crawford: Let's begin at the beginning. Tell me as much about your
family, and as far back as you can.
Blum: I have a couple of caveats. I've long since made up my mind
that even well-kept notes are not necessarily trustworthy, and
I never keep any notes. There's nothing I own that I think is
worthwhile enough to keep. People send me a letter. I get
through with whatever has to be done, and then I usually chuck
it, along with my responses.
So I just don't have the frame of mind that a properly born
upper-class person or an obsessive saver would have—that every
scrap of paper I have either received or filled out needs to be
saved for posterity. I've been spoiled by some magnificent
biographies, such as Churchill' s--which is really a wonderful
bit of writing—but I really don't trust the documentation he
provides, because I don't find in it some of the idiotic things
that he was responsible for, such as Gallipoli.
Crawford: You're talking about biographies?
Blum: Well, it is an autobiography, in Churchill's case.
Crawford: Are you talking about the war books?
'## This symbol indicates that a tape or tape segment has begun or
ended. A guide to the tapes follows the transcript.
Blum: Yes. I mean his whole series; all the volumes. So, I'm quite
sure that diaries and autobiographies aren't necessarily
trustworthy. I keep thinking, Will I really tell you some of
the down times I've had?
Crawford:
Blum:
Crawford;
Blum:
Crawford;
Blum:
Crawford;
Blum:
Crawford:
Blum:
Won't you?
I don't know. I mean, I just keep debating,
kind of lousy.
Some of them are
Let me tell you right at the outset that you should feel
perfectly free to tell me whatever it is about the down times
you want to.
Some of them don't speak well for me, you see.
Because you'll take the whole text and review it.
Oh, yes. I realize that, but do I or don't I want to get into
these things? Everybody tends, I think, to protect themselves.
I understand you're a candid person.
Yes. But I've got to be sure about this. So, one, I really
don't trust the best tended-to biographical material, and mine
is not well-tended-to. Second, I don't trust anybody's
integrity for sure. Third, I think each of us smooths over
some things—we'd like it to be seen more and more our way.
Fourth, how good is our information? Just recently I've
had a chance to look at the origins of the UCB medical school —
this experimental medical school called the Joint Medical
Program—which has been such a controversial, interesting
thing. Accidentally I recently ran into Chancellor Bowker, who
really carried the ball and created it. He has a totally
different memory of what happened than I do. He sees all the
problems that he had, which I have really ignored. I always
see the problems that I had.
Well, that's the value, of course, of your telling it.
And then a third person coming through—who really wasn't close
to it, but who would like to imagine he was because he was an
interested bystander— had a totally different version of it.
So here are three versions of the same thing, and I don't think
any of them are totally erroneous; but the focus is so off here
or off there or off elsewhere that any one of these stories by
themselves is really only a partial picture and therefore a
very different picture, emphasizing different actions and
different actors.
Crawford: Of course.
Blum: The worst of the caveats is simply that I think that if I had
done this history, say, five years ago, before I got involved
again with the medical school—the Joint Medical Program—and
with Tommy Kushner--who' s an ethicist in JMP who asked me to do
some presentations on ethics—that I would not have seen the
situations five years ago as I see them today.
I'm talking about the involvement of, "Okay, let's bring
out the ethical view, so that students and others can see what
some often overlooked issues are." You suddenly realize that
things that are very crucial now to an ethical understanding of
the situation didn't even exist at the time of the event— at
least not in my mind anyway. So, that by dint of going back
over parts of my career, I keep finding these episodes that I'm
not so sure were terribly ethical. Here I am lecturing to the
class about, "I thought this was good stuff, and look what I
did. Now, my god, I would like to retreat from that. I would
like to not even have been a participant."
Crawford: Well, I would think you would enjoy that— going back and
bringing it all forward.
Blum: I have enjoyed it, but I guess I'm saying that I have reason to
doubt the real authenticity, significance, of retrospective
stuff. It wouldn't make any difference how well I had
documented it then because I would have had a view that I was
doing good things. Now I look back in horror and say, "That
was not only not good, today it would be almost criminal."
Crawford: I wonder, aren't you being a little hard on yourself?
Wartime Experiment Using Human Guinea Pigs
Blum: Well, for Tommy's seminar, I found the article that part of the
seminar presentation was based on. I tackled the issues of
coercion in my career, my involvement in coercive activities;
physicians are always in the position of being coercive, you
know. But when I was in the service [stationed in Terre Haute]
during World War II, we experimented on human guinea pigs.
Crawford: Yes, you mentioned this to me.
Blum: Of course, it wasn't altogether horrible. Nobody got hurt.
Nobody was treated maliciously. We thought that everybody was
treated rather nicely--that is, the folks who were being
experimented on- -but notwithstanding, the whole setting was
terrible, in retrospect.
I would say that we were kind of pleased with ourselves,
doing that work. When we handed out the article,1 lo and
behold, it was endorsed by the National Research Council and
the United States Public Health Service, which also carried it
out .
Crawford: It was related to the Tuskegee Study?
Blum: No, no. It wasn't Tuskegee. Thank god I wasn't in that. Ours
was a smaller kind of a thing, but also an experiment on
humans. Somehow, the subjects being experimented on were not
really human beings. It was just how life was, you know.
True, but I was four steps removed from my boss who also was
the boss of the Tuskegee Study.
Crawford: I think that's what you told me.
Blum: Yes, and the boss was a lovely man--I mean, a neat guy--and you
would never have qualms about him marrying your daughter. He
just didn't know any better. Black people weren't people for
him. That was how he grew up in the South.
It was disgusting that we missed every call on it. I kept
squalling all the while because I have sort of an orderly mind,
and saying, "Hey, you can't do science this way. This is
garbage, you know?" And it was garbage, and nobody spotted it.
It was published, practically a book-sized article in a major
journal.
Crawford: But don't we have to feel good that we have a new perspective
with which we're looking backwards into history?
Blum: Oh, yes, we've come a long way, but I guess this is my caveat
about biography or autobiography, and that is: supposing I
hadn't really come back to the medical school, and supposing I
hadn't met Tommy and worked on several ethical things with her?
'Mahoney, J.D., C.J. Ven Slyke, J.C. Cutler and H.L. Blum,
"Experimental Gonoccocal Urethritis in Human Volunteers," American Journal
of Syphillis, Gonorrhea, and Venereal Disease. 30:1, 1-39, January 1946.
I was aware of ethics, but I wasn't that discerning. She
was the one that got me into giving a couple of lectures, and I
couldn't think of anything more pertinent than to take a look
at my own career. Wow. That was quite startling. That study
involving experiments on prisoners was my first significant
venture. Part of this experience I had was being coerced into
doing it wrong. I was in the service, in uniform, and I knew
we were doing the study badly, but I didn't object because it
was done under orders — shades of Nuremberg.
Crawford: You were aware that it was being done wrong?
Blum: Yes. It was so bad it was gross. I kept complaining to my
immediate boss, who had one half stripe more than I did. And
the excuse that you use is, "Well, I'm in the service and what
am I going to do? Am I going to fight it?" I did nothing
about it. Oh, I knew it was lousy work; and I don't think
anybody should be exposed to an experiment that ' s no good and
can never teach us anything.
Crawford: Did you say it?
Blum: Oh, yes, and my boss said to me--we had four layers of bosses
up to the guy who ran the Tuskegee Study, who was an assistant
surgeon general--"Look, when any of our bosses come through and
visits, just lay off this stuff." And he said, "If the boss
says that black is white, it's white. Get that through your
head." This was from my immediate superior. He too went on to
be an assistant surgeon general--! thought he would at the
time .
Here's this whole Nuremberg story of can you hide behind
orders, can you say that you had orders and therefore you can
do this, that, and the other? I never thought about such
things. I knew that it was lousy work, but I never thought
about the coercion. Of course, the prisoners on whom we did it
were coerced in a gentle way—they were bribed. Two hundred
dollars for an experiment. That was a lot of money for most of
those people. This was in Terre Haute, and the bulk of the
prisoners came out of either the ghettos of Chicago or, more
likely, from the hills of the Ozarks. Also, each "volunteer"
got a very positive letter to the parole board.
Crawford: What were the experiments?
Blum: Infecting them with gonorrhea, which was not a health threat to
our subjects because we already had penicillin. We were fussy
about the technical side.
Crawford: Infecting and then treating?
Blum: And then treating, but the issue was really to develop a
prophylactic for the armed forces that troops could take prior
to intercourse. Well, we never could infect routinely enough
to ever trust any work with prophylaxis. So we never got to
the prophylaxis part of the experiment. We just quit after a
year.
Crawford: Were the prisoners aware of what was being done?
Blum: Oh, yes. Oh, yes. Straight up. No question about that.
Crawford: It was the money that attracted them?
Blum: Yes, and a letter to the parole board. We would not call it
coercion. We didn't see it that way. We thought it was being
generous; but the truth of the matter is it's coercive as hell
to a desperately poor prisoner or one who needs a boost with
the parole board.
Crawford: They knew.
Blum: They knew, but it doesn't keep it from being coercive. In
other words, if you're poor and somebody offers you something
to pull you through, like real money—they couldn't get
cigarettes, or postage stamps, without some cash.
Crawford: A kind of coercion, isn't it?
Blum: Well, it ' s a version, I think.
Crawford: What do you wish you had done?
Blum: Well, I've since written a position paper that was used by the
California Medical Association--! was on their committee, the
equivalent of an ethics committee, from 1983 to 1991. This
paper said that prisoners should never be used for experiments
because they are in an unstable position. They're always
subject to fear or rewards that they couldn't get otherwise;
and so they're not necessarily willing participants.
Of course there were also very practical concerns, which I
learned by dint of making rounds, every night, on my prisoners.
And that is they traded every conceivable pill they got their
hands on. Illicit drugs cannot be kept out of the
penitentiary, not even narcotics. They're trading this all the
time for a cigarette, for a this, for a that, for a sexual
favor, whatever. So, you don't even know what else they're
taking or what they are not taking when you're doing an
experiment in a penitentiary; i.e., you can't say what is
really going on with your guinea pig.
Crawford: Which really invalidates everything.
Blum: It invalidates the whole business from scratch. Well, I don't
think we understood that then; but when I wandered around the
penitentiary at night, making rounds and talking to each of my
"good" patients, I discovered this reality. They leveled with
us because we were not doctors working for the penitentiary, we
were outsiders. So, the doctor gets a little extra trust.
Crawford: Was there value in what you learned?
Blum: Well, some value in what I learned, yes. So I have no
hesitation in presenting a lecture that said, "Not only is this
research probably valueless because we didn't know what we were
doing, we also didn't know what the patient was doing." In
another sense the patients are not really free actors. They're
being bought and sold. Practically speaking, it was
interesting that we did have about one in ten prisoners who
would neither take the money nor the letter, who felt that they
were expiating their crimes or sins.
Crawford: The letter?
Blum: They wouldn't take the letter to the parole board, and they
wouldn't take the money. They said, "I'm doing this because
I'm trying to do some good." Now, that's the kind of person
that you probably should be doing experiments on. If you're
going to have human volunteers — if you tell them not to smoke,
or not to do this, or not to do that, they won't — and they want
to do whatever the experiment calls for. They have their own
reasons for wanting to do it and helping society, as they see
it.
Crawford: When you talk to your public health students about this very
issue, what do they say?
Blum: It was one of a good many examples of ethical ignorance—it was
so gross that I don't think the students got overly involved
with this one. There were some less clear-cut versions of
unethical actions that they and I thought were more
interesting.
Crawford: But are they horrified? Or are they weighing, balancing--?
Blum: Since I was telling the tale, students can't be too horrified
with me. Their attitude has more to do with the spirit of how
I presented the matter. Acknowledging our ignorance and
pointing out the strong support we were given by the nation's
top scientific bodies to do the study effectively puts the
blame elsewhere, on ignorance and perhaps on the urgency of war
needs.
This study was number one on my list. It began my career- -
my first work when I became a physician, my first real job.
Here I was, subject to coercion. I didn't dare talk back to my
bosses, and used that as an excuse to myself.
We even had another form of coercion on that project which
I thought was funny--and this was really my own doing. My
boss — the one who told me, you know, "when the big boss comes
in," and, "black is white is white, "--was a person I totally
despised. Everything about this person ran contrary to
anything I'd ever been taught a decent human being should be,
let alone a smart one, who could even be an M.D.
There were three of us working under him: two lab techs,
who were nice people, decent human beings; myself; and he was
our boss out there on the site in Terre Haute. We figured out
very soon that he didn't know anything. He knew no medicine,
he knew no lab work, he knew nothing. He was a miserable
hypocrite. He couldn't even do a physical exam.
Crawford: But he'd been told by higher authorities what to do?
Blum: Well, it wasn't that. He made his way through medical school,
sounded good, knew all the text book stuff. He couldn't
examine a patient or know what he was feeling, seeing, or
thinking. Thank god he went into administrative medicine. But
coming into the lab and hearing the lab techs say, [half-
whispering] "Come over here. The boss says these are red cells
and he's crazy. I mean, it just ain't so." But they couldn't
tell him any thing- -they were too far down the ranks.
So I went over and looked at the slide, and I could see
that he was mislabeling red cells and calling them white cells.
Well, it wouldn't change the world, but just the same, that's
not science, you know, and could be unfortunate if one of our
clients had an untoward result.
So I said, "Boss, we need to go through some things. We
have to learn how to agree with one another. Now, let me cut
my finger and put some blood in the specimen, here." Which I
did. "And, let's look at what a red cell looks like in a spun-
down urine specimen." So, he got to learn for the first time
what a red cell looked like.
Crawford: That is shocking.
Blum: Well, this is a man who had been out of medical school for five
years. So that's the kind of circumstances we worked under.
You don't have much respect for a boss like that: technically
insolvent, morally insolvent. You know, it was tough.
Crawford: Did you do what you could?
Blum: Yes, but the experiments I couldn't change. They were all
worked out. First we were going to do this, then we were going
to do that. These were crazy experiments. They were stupid,
they never changed less than two or three variables at one
time, so we couldn't attribute the results to any one thing.
You couldn't learn anything.
Crawford: You still read about this today, don't you?
Blum: Yes. Well, today, I don't think people are stupid, they're
just vicious or dishonest, but then it was stupidity. Anyhow,
so we used to be absolutely uncivil to the guy. We had to eat
lunch together each day, and when he'd come in the lab, we just
sort of said, "Get out. You're contaminating the atmosphere."
This was our boss, you know. We had it pretty well figured
out. We coerced him. We never discussed it as such, but we
thought a good administrative boss can't acknowledge that he
has lousy assistants. If his superiors find that everybody
that works for him is not very good, there's something wrong
with the boss. He wouldn't dare give us all bad reports, and
he didn't.
Crawford: All three hundred percent?
Blum: Right, right. So, we coerced him. That was a different
version of coercion, but that one situation had all these three
levels of coercion. The nature of the experiments, the
prisoners, and the staff mistreatment of the boss. I think
that was kind of interesting.
Crawford: That's very interesting.
Blum: If it hadn't been for Tommy, I'd have never spotted the gross
nature of the experience.
Crawford: Oh, I'm certain this worried you all the time.
10
Blum: I don't know. Three levels of coercion in one show. We lived
with it for almost a year, eleven months.
Crawford: But doesn't everybody, including students, have these kinds of
confrontations and conflicts?
Blum: Oh, I'm sure many do. But at the time, only one version of the
coercion came through, and that is that we were ordered to do
lousy experiments. But I didn't rebel at being forced to do
them--I just took it for granted and accepted it as part of
service life.
Crawford: Do you think you dealt with your superior in the best way that
you could?
Blum: Not effectively, never complained above him, just like he never
went above his superiors.
Crawford: This was your first such confrontation?
Blum: I suppose, yes. Even our boss' wife was aware of his view of
getting ahead. We all lived near one another. We all came
from Stapleton, that's Staten Island, a big marine hospital,
part of the armed forces during the war, and it meant that in
those circumstances, in a pseudo-military situation, the lower
ranks have to salute you, and you've got to salute back, you
know. When somebody comes along that's got more braid than you
do, you've got to salute them.
His wife tells us how he's just coming out of the PX
entrance with a great big bag of groceries in each arm, and up
drives an admiral. Here he is, what the hell does he do now?
[laughter] So he drops both bags and salutes. She just loved
that story, and I do, too, because it's too close to what
taking orders can become. [laughter]
Crawford: That's the way you like to remember him?
Blum: Yes.
Crawford: Well, I suspect your students are very lucky to have this story
presented to them because it ' s a real story--tangible--it ' s not
just ethics in the mist.
Blum: So we went on in class about ethics, along my career, and we
walked into bad situations. Very bad--.
Crawford: After that?
11
Blum: After that. Yes.
Crawford: In the service?
Blum: Well, I was out of the service in four years, and I was treated
royally in the service. I really can't complain about that; I
got all good duty assignments even if the workaday realities
left a bit to be desired. There was one momentarily shocking
episode to which I'll return later.
Crawford: But isn't that why every medical school has an ethics section
now?
Blum: About two-thirds still don't; and what's worse, those that do
usually talk about hooking up somebody to life support or
unhooking them, or allowing people to make decisions. The bulk
of these people that you're worrying about are going to die.
Some of them wish you'd leave them alone. Often their families
are torturing them, and you're caught between the family and
the patient, when you're supposed to be worrying about the
patient. For sure, we need to know these things, but there is
so much more to ethics.
Crawford: We're a long way from our humanity--.
Blum: A long way, but I regard these end-of-life confusions as
relative trivia. The real ethical issues are denying health
care to people to begin with — people who had become sick. The
routine: "Well, I'm sorry. You're not eligible. Good bye."
Their eyes may be bugging out of their head, or their legs and
feet are swollen and oozing. You look at street people with
legs like this, many of them from standing in cold, heat, wet,
and standing, standing, standing. Or maybe they have just a
little heart disease thrown in, and they have no coverage-- just
40 million presons without coverage in the U.S. today. These
are the real ethical issues.
Crawford: That isn't something we used to have to deal with in great
numbers .
Blum: True, but we're sure getting used to it. For this ethics
class, where I was able to produce two hours' worth of
material, I started looking at different aspects of what I had
done, and some that I was only modestly aware of.
12
Parents and Childhood in Napa
Crawford;
Blum:
Crawford :
Blum:
Crawford:
Blum:
Crawford:
Blum:
Almost the first thing you said to me was that when you were
very small, you were drawn to public service—you knew that
there was some kind of expectation and mandate for public
service from your father and mother.
Well, to go back to my childhood, neither of my parents ever
went to school. They had no formal education, and they came
from tiny Jewish communities somewhere between Poland and
Russia. They were on the border, and so sometimes they lived
in one country and sometimes in the other without having to
move.
Where did they meet, and what were their full names?
Here in San Francisco. Pauline Leplin and Haiman Blum met
about 1906 after the earthquake and fire. Neither had family
here initially, but ultimately both had brothers and sisters
come to San Francisco, some then leaving for New York, Los
Angeles, Mojave.
Were they farmers in Russia?
Jews in Russia or Poland couldn't be farmers. You couldn't own
or have any real ties to the land. You might sell produce, buy
and sell, but you couldn't farm. It was verboten in Russia, as
it was in most European countries. Neither of them went to
religious or secular schools, so their exposure to education
was really through apprenticeship and living. My mother was
apprenticed as a dressmaker in a well-to-do home. She lived
with the family for nearly a decade. The woman was a well-
known opera singer, and my mother just made clothes for that
lady.
Do you remember the name of the singer in the family?
The opera singer?
nothing to me.
No. I probably heard the name but it meant
My mother spent her life in Russia until she was sixteen,
making clothes on a very elegant scale. She probably had
marvelous teachers, people who could have elegant clothes made.
She was a superb seamstress, and when she came to this country,
in various hard times, she turned back to that to make a
living.
Crawford: Was she elegant? Did she like to dress that way?
13
Blum: Nope. It didn't mean a thing to her. She did like her clothes
to be just so. I mean, there's no such thing as a sloppy hem
or a bad-fitting garment; but as far as elegant, no; but if you
made a garment, it ought to be just so. She made all her own
clothes, most of mine when I was small, even shirts when I was
in high school.
Crawford: High standards.
Blum: Yes. Nobody ever sold shirts like that. They were things of
beauty. Even I appreciated how elegantly they were made.
Everything was done just right. Well, by the same token, she
learned about the world of opera, music, literature.
it a
Blum: She read all the great Russian authors, certainly, and some of
the English and French, too. So, it wasn't a boring existence,
even though she had never gone to school, she'd learned
probably a hundred times as much as she might have in any
school that she could have gotten into.
Crawford: She lived with this family?
Blum: She lived with them, yes. So it was a pretty good background
without ever going to school.
My father had a really different experience. At age five,
he was apprenticed to a woodworker. The virtue of these
apprenticeships is that they feed you, and they house you, and
they are exacting. He never went to school, but you know,
being in a Jewish community, they were always exposed to
pogroms and in their teens faced the reality of going into the
armed forces. Being in the armed forces was not too much
different than a death sentence. They'd probably find some way
of getting rid of you, disposing of you, and you'd never come
home .
Crawford:
Blum:
The environment was probably somewhat radical in these
apprenticeships; and the people you apprenticed for were
probably Jewish, too, and probably radical. So there was no
being part of the synagogue, no studying the Torah, and all
that sort of thing.
When you say radical; define that for the purposes of the
history, if you would?
Politically and socially radical; i.e., being a socialist.
Who were their heroes? The heros were writers. After all,
Tolstoy was a religious, peculiar figure; but his standing was
very much pro-social justice, and he felt that human behavior--
whether you were rich or poor—had to be decent towards other
people of any class. So you start with that, and then, of
course, you immediately get involved with the sort of romantic
figures — the Victor Hugos and Emile Zolas--who were, all said
and done, very pro-social justice. This was socialism.
Crawford: And they would have been exposed to those writers--?
Blum: Oh yes. Yes, they had all been translated, and they were
exposed. My father was one of the best-read men I ever knew.
He read everything, I mean everything. We'd go to the library,
well, he'd tell you about this, and that, and the other thing.
He'd read it all.
Crawford: He told you about Zola?
Blum: Early. I was probably five or six when I started reading that
kind of literature.
Crawford: I remember you told me that.
Blum: By the time I was eight or nine, I'd gone through whole
sections of the library.
Crawford: Did your father have an extensive library?
Blum: No, no, he used the public libraries.
Crawford: He used the library, yes.
Blum: There were two nice libraries downtown- -about three miles away.
Every Saturday we always had to go to the library, that was
part of the routine. You just knew you were going to the
creamery because we had to deal there, and you knew you were
going to buy some groceries, and you knew you were going to the
library. That was just par for the course. You never skipped
that. Well, rain or shine, too; and originally, I guess, in a
horse and buggy; although I don't remember a horse and buggy.
I only remember a car.
Anyway, my father had this tremendous exposure to politics
and literature and left Russia before he was drafted. All his
brothers came over, and they brought the sisters, and so on.
It was a large family, but other than my father they were not
intellectually or politically oriented at all.
15
Art meant little to my father, whereas to my mother it was
a big deal. Her treat in life was to go to the city (San
Francisco). We lived up in Napa, and we would get on the train
in Napa, and go to Vallejo and get on the boat, and go to San
Francisco. Then we'd spend a couple of days, and a couple of
nights going to operas or a ballet or a concert.
Crawford: Oh, she brought you to the theater?
Blum: Oh, yes, yes.
Crawford: Your father as well?
Blum: No. Never, as far as I can recollect. So it was a different
stance. They knew the same literature, they knew the same
political logic, but he was much more politically active, and
she would say, "That was interesting." She didn't disagree,
but that kind of action wasn't critical to her life.
Crawford: So, what he took from the great novelists was the political
ideology.
Blum: The political. If you read Zola you can't help but get that
sort of thing. Victor Hugo and Charles Dickens, likewise.
It's there. You'd have a hard time missing it. Well, I think
you'd have a hard time missing it in Shakespeare, too.
So this was the kind of a background. No siblings. I was
delivered by Caesarean, and in those days few of our friends
seemed to want a second child, least of all my mother. We
lived on a farm. Looking back at that era now, it was fine to
live in the United States, where I started. There's a book
recently out called Comrades and Chicken Ranchers that recalled
many things for me.
The Community in Petaluma and Farming in Coombsville
Crawford: You told me about this book. Was it about the Petaluma
community?
Blum: Petaluma community.
Crawford: Talk about that, would you?
Blum: Well, really, my folks were kind of clever, as I look back on
it, by not going there, because so much of their lives in
16
Crawford:
Blum:
Crawford:
Blum:
Crawford:
Blum:
Crawford:
Blum:
Crawford:
Blum:
Petaluma would still be reliving what they had escaped from.
It was typically Poland, Russia, in terms of what people argued
about and believed in.
In other words, they wanted to stay away from those populations
when they settled here?
I think so. I think they didn't want to lose them, but they
didn't want to live in them because everybody was very
argumentative, and nobody was in agreement with anybody about
anything. I'd say about four times a year, we went to visit
families in Petaluma. They really only occasionally came to
visit us. This involved a two- or three-hour trip with lots of
flat tires.
They weren't relations?
No relation. These were people who had many similar kinds of
experiences and feelings about things. Reading this book, I
can mostly understand now what was going on. For instance,
there were tremendous battles between the Zionists—they ' re all
the Jewish people who wanted to create a strong and great
Israel where all Jews would be equal and would have reasonable
opportunity—and the anti-Zionists, which my parents were, who
said "that's no solution to anything. So, it's great for the
Jews, but how about creating a world where it would be great
for all peoples? Jews aren't that important." That was a
miserable minority view because "Jews are the chosen people" in
the eyes of most Jews. Both my parents were thrilled with the
idea of being in the U.S.A. and working for the betterment of
peoples here and everywhere in the world.
A very strong view, yes.
They
My folks were saying, "What's so chosen about the Jews?
must be pretty corny if all they want is something for
themselves." Well, you see, we didn't have to get into that
battle but maybe a couple times a year, and we picked families
to visit who felt more or less the way we did about things.
To be your friends?
Yes.
Were there organizations?
Yes, there were many, some of which cut across these Zionist
divisions. There were many Jewish families whose goal in life
was to make it big. Zionism was not the issue for them. These
17
people were further subdivided into those who wanted their
children to be professionals and others who wanted them to
become successful businessmen. Even further apart were those
like my parents. The things that really counted in my
childhood were from my mother's standpoint being an artist of
some sort, or an intellectual or writer.
For my parents, making it wasn't what living was all about.
It was about making a living, all right—you shouldn't be
starving, but you should be worrying about a decent society.
So any of those acquaintances who became significant business
successes slowly were dropped out of sight, we just didn't
associate with people like that.
Crawford: Looked down upon?
Blum: Yes. We just didn't associate with them.
Crawford: Did she write or keep a diary?
Blum: No, no.
Crawford: She was busy.
Blum: Yes. We were on a farm, and she did more work than my father
did. That's an old Jewish custom, of course. The men prayed
and studied the Torah (my father never really did), and the
women made a livelihood for the family, took care of the home,
the husband, children, and everything else. So it wasn't easy,
but it wasn't something she thought was remarkable. One
worked, that's all; and if she could do more, she did more.
Now, of course, for many years off and on, when things were
tough, my father, who was an excellent cabinetmaker, went to
work full-time, earned good wages, and my mother did most of
the work on the farm. Heavy duty tasks fell to my father at
the end of the day and on weekends.
Crawford: What was the balance?
Blum: Well, fifty-fifty. About half the years were bad so he had to
work away from home. About the half the years we could see a
possibility of earning a normal living off the farm, so we all
worked on the farm. [laughter]
Crawford: But you always had good food, you said?
Blum: Oh, always, because he was a disciple of educated farm
management people. He doted on UC Davis, which was the aggie
school.
18
Crawford: Were there resources there for him?
Blum: Well, yes, because they had farm extension services — they still
have. So, if you're in grape growing country, there's an
extension agent there who really knows about grapes. If you're
in chicken country, he knows about chickens; and if it's
turkeys, it's turkeys. We always turned to those people for
advice. They've got booklets, and they come out, and study
your situation and advise you. If you have a sick plant or
animal, they'll take it and get a diagnosis for you. It's a
really remarkable relationship—the old land grant colleges to
the farmers— that was the tie. That was meant to be the tie,
politically.
So, at least once a year, we would go to UC Davis. That
was Aggie Day. It was open house for actual and potential
clients. People gathered from all over California up there at
Davis. We always went, and it was kind of a holiday. You got
to see all the wonderful cattle and sheep and goats and
chickens and orchards, and all kinds of new gadgetry and
methods. But in between time, you didn't have to go there.
The extension people would get this stuff for you. In my
childhood— 1915 to early twenties--! think, looking back on it,
they also had an intellectual plague — they kept teaching self-
sufficiency. That meant diversification.
Crawford: A plague?
Blum: I call it an intellectual plague because they were certainly
not concerned with the farmer's survival in a practical sense.
We had forty-two acres, and we had twenty kinds of food crops
on it. Well, you can't make a living from anything with twenty
tiny different crops.
Crawford: But they proposed that?
Blum: They said, "Well, you should raise these kinds of apples: this
is for early, this is the middle, this is the late, this will
store." We had ten, fifteen kinds of pears; apples— at least a
dozen kinds; cherries— a half a dozen. It's insanity. I mean,
you can't sell them. You've got more than you can eat, but you
can't sell them because you don't have enough of any one kind.
We concentrated on giving things away.
Crawford: So, with a single crop, you would have been able to do better?
Blum: On occasion, with a single or a few crops, you at least had
volume enough to attract somebody to buy it, but you couldn't
sell ten boxes of this or five boxes of that. For a brief
19
period of time, Safeway in its early days would buy such small
quantities.
Crawford: About when did Safeway come?
Blum: It's got to be in the twenties. If it wasn't Safeway, there
were some other outfits: Scaggs, Purity, and Piggly Wiggly.
Crawford: And they could buy small amounts?
Blum: They could, but it wasn't long-term good business for them;
they were just wasting their time.
Crawford: Not the way they market?
Blum: Not the way to do business. If they bought an item for one
store, then this store has to get rid of it, but they couldn't
mass advertise it. Folks have to come in and see it because
they don't hear about it and can't plan on having it. So the
farmers who diversified were practicing a kind of economic
suicide. But we did eat well.
Crawford: Did your mother can like crazy?
Blum: Oh, yes. The house had a full basement because that was the
hatchery — ultimately the main activity was raising chickens,
and often turkeys. But much of that basement was filled with
canned fruits and vegetables of our own production. Poultry
meat we always had available.
Crawford: That was in the days before freezing, I suppose, of meat?
Blum: Yes. I should say that the hatchery was seasonal, but a major
undertaking. We had two, three, four, five thousand chickens
and we hatched them all. So Mother had a short eighteen-hour
day which included turning each egg twice a day while it was
hatching; and when the chickens began laying, before shipping,
each egg had to be candled--put it in front of a light to see
that it was free from blood spots. Today chicken farms have
millions of birds, but then all the work was done by hand--
every bit of it. We even mixed up the mash they lived on by
hand, distributed it to each chicken house, likewise cut the
greens and distributed them, and collected the eggs twice a
day.
Crawford: You did a lot of that?
Blum: I did some of it. There were times when I did, especially when
school was out, although I'd more likely be involved with the
20
crops than with the chickens,
see .
It went on simultaneously, you
Crawford: Now, was this diversification true of the farmers you knew in
Petaluma, as well?
Blum: No, in Petaluma I don't think there was a fruit tree in the
lot. They went into chickens pretty exclusively. And when we
were raising three or four thousand, some of them had thirty
and forty thousand, primarily white leghorns. These were for
eggs and, also, the young male ones for meat. So, in any case,
they would have great years and bad years, but as this book on
Petaluma brought out, there were a few years in which many
poultry raisers got liquidated. When you get liquidated with
only one crop, that's all you've got to eat. They really got
liquidated.
Crawford: Who published Comrades and Chicken Ranchers?
Blum: Kenneth L. Kann, Cornell University Press, 1993.
But that kind of a life on the small farms meant that
farmers lived at most a few miles apart—but at least a block
apart — from most people. It meant you went to a country
school. I went to Harmony Country School. Children came in
from about a mile radius. It was a wonderful community in an
international sense. There were a few families of English
background, several Irish, several Scotch, there were Swiss and
Romany Swiss gypsies. There were Italians from several
regions, there were French, Alsatians, Australians, there were
several kinds of Germans --Bavarian and otherwise. There were
Polish, American Indian, Jews from Russia, Portuguese, Danes,
but no Hispanic or black families.
Crawford: Was there wine activity already?
Blum: No, not a great deal because it was Prohibition most of that
time. Some people were gambling, as we did, that it would be
gone, and so started planting vineyards; but the wine business
was dead. And we lived in a part of Napa that is not ideal for
grapes to this day.
Crawford: Where was the farm?
Blum: In a place called Coombsville, it's just due east of Napa, and
the road doesn't quite go anywhere. It's not the road to
Sacramento, that's a little different; but it goes up into some
hills. Vallejo City used to have its water supply there. It
moved the water from up there in Napa down to Vallejo.
21
Crawford :
Blum:
Crawford :
Blum:
Crawford :
Blum:
My father just had a wild old time. I'd get in the car
with him—usually my mother was busy — and we'd go visit the
Pole, and we'd hear about things. He had a radio set about
four feet long with a hand full of dials. He got news from all
over the world. Next door to him there was an Englishwoman who
wrote for various papers and magazines.
The English lady, who'd been a writer, was kind of fun. She
was a very vivacious character. She had a prune orchard and
didn't know a damn thing about it; and my father would always
tell her what to do next. We also had a Scotch man up the
street, and he grew apples about eight inches in diameter; they
were just indecent to us ordinary farmers. He'd remove many of
the apples on the tree and leave a dozen, and he'd sell the
dozen for more money than anybody could make by the usual
methods of raising apples.
Well, I'm thinking of the kinds of people that we had. All
of them sort of spoke English; it was our common language, and
we all got along. Some of them were in the same mess we were
with diversification, and some were not. Some were poor-
nobody was really wealthy. My father was a great organizer, so
he helped organize the school district, and this and that. The
school was already well-established when I got there; but they
finally combined with another district and got a bigger school
and more teachers and buses after I had graduated.
Good school?
Good enough, yes.
And certainly international.
Oh, yes. That was good. Our Native Americans were showpiece
people. They were the favorite family around—mother , father,
two grown sons. Everybody went to visit and look at them
because they were so beautiful.
They weren't ostracized?
Oh, no. No, they were elites. They were carpenters or
something--well-skilled. They were Carlisle Indians and their
name was Carlisle. They'd been well-educated, probably spoke
English better than most of the others in Coombsville. They
were also very friendly people.
Crawford: Kept their traditions?
22
Blum: Not really. No, they were Americanized. They were just
handsome, tall, well muscled, slightly reddish smooth skin,
somewhat acquiline features, gorgeous.
Crawford: Were there churches for all the different faiths?
Blum: Well, the churches were not out there. This community was out
in the sticks, but it went the three miles downtown to the
churches. I didn't even know there were Jews downtown. On
thinking about it, it turned out there were. The druggist was
there—we always patronized that druggist—well, it was the
main one; and the hardware store; and one of the clothing
stores which we couldn't patronize—it was too elegant; and one
housewares family; and there was a cider factory. These were
all Jewish families. Oh, and there was a huge tannery, and
it's still in business in the Bay Area. Those were Spanish-
Jewish people, and I never dreamt they were Jewish: they were
so fancy and they were among the elite of local society.
Living in the country, I never had any idea there were other
Jews around.
Crawford: Really? Didn't talk about it?
Blum: No.
Crawford: Your father wasn't a religious practitioner, was he?
Blum: Oh, lord no; and I don't know if these other people were or
not. There was certainly no synagogue. We had one Jewish
family neighbor and I believe my father had talked them into
moving out there. They brought some uncles and brothers along
with them, who were as highly skilled as he was. They were
machinists and machine operators. They had to commute to San
Francisco, though, where their work was. So they finally gave
up after a few years, as their farm was even more useless than
ours for making a living.
That was the only Jewish family that I really knew, and
they lived near us for three or four years. They had a boy
older than me. This was part of my Jewish experience. It was
interesting because they weren't the least bit concerned with
the arts or ethical and political issues. They kind of went
their way. They were the making-it crowd, although at one time
they had been more political. That kid and I both hit grammar
school at the same time, and he was a great success. Everybody
loved him. He was a good athlete, small, but could do
any thing- -tough, courageous, very, very gregarious, the perfect
ail-American kid. And here's me a year behind him, playing the
23
piano, stuffed shirt, couldn't mix with the kids. I was a year
or two younger.
Crawford: That was a kind of an intellectual disparity?
Blum: Yes, and more than that. I was always smaller wherever I was
because I was younger. So I started retreating, and then I
commenced to treat myself as a superior. That's part of it,
I'm sure: the defense—because I couldn't play football and
couldn't run fast enough, or hit a baseball- -was to look down
on the "clods" who could.
Crawford: But you played the piano.
Blum: Yes. And that's a big deal. You earn a lot of cordial hatred,
and you in turn despise these people who think you are a sissy,
and you look down on them as poor low-brows who play football.
Crawford: Did you exaggerate that or did they react that way to you?
Blum: Oh, yes, because on the way home, I used to get beaten up, and
they'd call me interesting names and so on. It wasn't too evil
and it wasn't too vicious, but it was clear that I was a Jew,
yet this other Jewish kid never got this. He wasn't a
ringleader in their activities when they were pestering me, but
he was totally acceptable to the other kids and I wasn't.
Crawford: And that was on the basis of his being an athlete, I suppose.
Blum: Well, no. It was on the basis of being a real all-around guy,
you see. He wasn't a nuisance. I mean, he was one of the
folks, and I was not. One could say that this was
discrimination because I was a Jew, but the truth of the matter
is that I wasn't one of them and they just found that I was
Jewish, and that was handy- -something to torture you with.
Crawford: You were different.
Schooling
Blum: Yes, so they made an issue of my being Jewish; but, in fact, as
I look back I'm sure that had nothing to do with it because
there was our Jewish neighbor having a great time.
Another awful thing happened. I skipped the second grade,
and this helped set the stage. This is a little country school
with about forty kids--and about that time they divided it into
two rooms with twenty each: the first four and the highest four
grades. So, I'm the guy that skipped, and they had never had
that, apparently.
Shortly thereafter, the state examiner came by. That was a
big event, the state examiner. Here I was in the third grade
down here, and there was the five to eight grade room. They
took me into that room, and had me read for the state examiner.
Crawford: Into the fifth grade?
Blum: Well, in front of grades five, six, seven, and eight. I'm
reading for the whole school so the examiner will be impressed
with how well we read.
Crawford: So you were definitely singled out.
Blum: Oh, boy.
Crawford: Which is never good?
Blum: Yes. [laughter] Particularly when it's clear that you were
chosen as the one that can impress the state examiner, and the
rest of the people are sort of --if you can just keep quiet,
we'll do better. [laughs]
Crawford: That's teacher's pet, magnified by thousands.
Blum: Oh, yes. So I can still see it; and I enjoyed that, you see.
I mean, I wasn't unaware of what was going on. I still get a
kick out of it.
Crawford: You liked being different?
Blum: I didn't mind it for a positive cause, i.e., showing that you
can read. Subsequently, I had a lot of anti-Semitic remarks
made, and was beaten up on the way home from school and this
thing and that thing; but I don't think it was really anti-
Semitic at all--.
Crawford: It was just being picked on.
Blum: Yes, but it would happen to a Jew, though, because that's
exactly their tradition of being into cultural things,
intellectual things, reading—you know, the whole shmeer.
Crawford: Would there have been only two Jewish families in this school?
25
Blum: Yes, and the other family was soon gone.
Crawford: The school was out of town.
Blum: Out of town in Hannony--a little country district. There were
only forty students, even at its maximum. The school's still
there. The building's kind of cute. Somebody cleaned it up,
and it's a home now.
I went to the town school at about the seventh grade or
eighth grade. You weren't supposed to, but my folks figured
that I wasn't getting everything that I should get in Harmony.
So I switched to the town school. Unfortunately I had also
skipped the sixth grade, so I couldn't parse sentences when I
got to town. So this is the bright kid coming to town, and I
missed the world of parsing. I still don't know what it is.
It just scared the hell out of me to be such a dumbbell in
front of the whole town class.
Crawford: Nobody parses anymore.
Blum: Well, I knew I wasn't missing too much because it was clear
that I knew more literature than the teacher. I knew more math
than the teacher. This was the good town school. It was clear
I was in great shape, except not in phys . ed., and not in the
carpentry shop. I could no more do what my father did than
fly, perhaps I was blocking because I couldn't stand him.
Crawford: And your father was so skilled.
Blum: Well, first, I wasn't allowed to mess around at home. That
was, "Well, you won't do it right." So I worked out an
arrangement when I was probably eight or nine. The steps were
falling off our house, which was up above this big basement.
My father said he'd fix them. So he bought the boards and they
lay around for two or three years. Stair boards are expensive
and nicely-shaped, rounded edges, and so on; but they don't go
on the stairs by themselves. They just sat. The railing
started to fall off.
I cut all the stairs to size, cut all the risers. And I
did all that very secretively, and filched the nails, and
tucked away the tools; and then one day when I knew my father
was going to be gone for several hours, (I didn' t go downtown
on that Saturday) I stayed home, and I put those stairs in.
And we had some bitter times over that because this was a
"lousy" job. It really wasn't done very well, but the stairs
were solid and safe and I felt good every time I looked at
them.
26
Crawford: It was done.
Blum: Done, you know. So, to this day, I have strong feelings
against perfection.
Crawford: It's intimidating, isn't it?
Blum: Not only that, it's a way to see that nothing happens. I can't
say that my father didn't want anything to happen, but he
certainly didn't make the stairs happen while we waited for the
perfect job.
Crawford: Well, he wasn't afraid that he wouldn't do a perfect job, was
he?
Blum: Oh, no. All the while he wasn't doing it, he was out
rebuilding somebody's house or barn for free. This used to
gall my mother and me. He'd go over there, and he'd set in
cabinets for a neighbor; and, it was nice--I don't begrudge him
the fun of doing it- -but he could have done our stairs in the
course of one of those jobs.
Crawford: Never did appreciate your stairs? He never did?
Blum: He never took them out. Then, when I put in the second set,
the back stairs, well, we didn't hear about that. [laughs]
Crawford: Good for you.
Blum: We had a long—half-mile long- -driveway through our farm, and
it was just a big mud hole. We had a little stream that would
run through in the wintertime, and would wash up a lot of nice
gravel. So I had a kid's wagon, and I'd load up the gravel and
haul it into all the mud holes; and, you know, after a couple
of years, we had a pretty good driveway. He didn't object to
that.
Then, once, when we switched over to raising turkeys, we
had to build a huge chicken house that was two hundred twenty
feet long. That's a lot of chicken house. It was about
twenty-four feet wide. It was also built for chickens, and
there was a roost--a platform and the roost on it--and I did
the whole thing.
My father and some neighbors poured the concrete floor.
That was a big job, and I helped. Then, when it came to
putting up the wood, I did it all. That was quite a job. It
took me the whole summer. That was kind of fun. So, again,
perfection was not my style, but we got it done.
27
Crawford: That's right. Was he very exacting?
Blum: I think he gave up on me. For himself, yes. I mean, even if
he was just patching a barn or a door latch or something:
everything just so.
Crawford: What were your parents' expectations for you?
Blum: Oh, from my mother it was very clear. I should amount to
something—be a writer, an artist.
Blum:
Crawford:
Blum:
Crawford:
Blum:
I should also be capable of making a good living, but that
wasn't regarded too highly. One could be a doctor, one could
be an engineer as second best. It turned out that my talents
were not as a musician, and not as a writer--.
But she would have loved that?
Yes. That would have been good,
ranch.
We even had a piano on the
Well, we'll get to that. We want to explore that, too.
So they settled for my doing engineering, creating structures,
you see. Not the kind of thing you think of today, more the
heroic stuff: the bridges, the big building. So that's what I
settled for, and, since my math was adequate, and since
drawing- -which was not my forte--didn' t seem to be imperative
for engineers, although many of them are good at it; why, we
all settled for engineering. My father really had very little
to say about all that. In fact, at the time I went to college,
I think he would have liked me to have stayed on the farm and
just done the work. Except there was no farm because it was
the Depression and the farm went for the mortgage.
High School Egalitarianism and Elitism
Blum: Something more about my childhood, before we get to UC. The
truth of the matter is that one part of me is totally missing;
and that is that I was brought up, as I said, never to fight.
A physical encounter was absolutely for animals. It was just
inconceivable that you fought people with your fists or any
other way. So there was very little fighting in my life, and
certainly very little fighting back; and other than the gentle
28
Crawford:
Blum:
Crawford:
Blum:
persecutions I described, which weren't all that bad, I was
never in a fight. In the country situation, we were spread out
enough so you didn't have to fight. It wasn't like being in a
ghetto or in the big city, where you had to fight for
everything, I gather, at least nowadays.
So, when I got to high school at age eleven, I started gym.
The people I was tossed in with were from mostly fourteen to
eighteen. At eleven years, you're not too well-formed; I
wasn't. I had a hell of a time with gym, and got to dread the
gymnasium, and the tumbling—all that stuff. I was just scared
to death of it and stayed away from it as much as possible;
and, at the same time, I was thriving on the intellectual side
in high school.
The intellectual side, as I indicated before, is heavily
weighted towards fairness and justice, and romantic ideals
about just people, fair people, the whole bit. So finding that
that wasn't typical of my classmates—who really hadn't read
much of anything, thought about anything, didn't care about
politics as I did, which was in our house all the time— I
developed this interesting dichotomy of being very much an
egalitarian in spirit, and very much an elitist in reality.
This really hung on for all my life; and I was well aware of it
when I got to the university. It's kind of an oddball
combination, supposedly; but not oddball at all, it turns out,
it's very common. One of the things that you do is to put
aside the physical people: the athletes and the folks who
really do all the wonderful things in the way of dance and this
and that, unless it's on stage. And by being a clod, in fact,
you sort of protect yourself by being an elitist. So you're
above all this physical expertise, and that isolates you even
further.
Yes. I can see it.
It
just really has plagued me all my life.
Weren't there students like you?
Very few. I had very few friends. The handful of friends I
had were all oddball. One of the close ones just died the
other day. He came to see me, thought he was dying, and
thought we might not see each other again, and so he set up a
visit. He's a little older than I. He was a huge Irish kid,
Catholic, who lived right on the banks of the Napa River where
it always flooded. Their house was on stilts. They were poor,
desperately poor. His mother was a washerwoman- -a woman over
from Ireland— a wonderful lady, who had horrible hypertension.
29
I just can't believe what her blood pressure must have been
before she died of a stroke.
Crawford: How did that manifest itself?
Blum: She was red in the face, and she was very volatile. You just
knew she was going to burst one of these days in front of you.
Crawford: And she was not treated for hypertension?
Blum:
Crawford:
Blum:
Crawford:
Blum:
Crawford:
Blum:
Crawford:
Blum:
Oh, there was no treatment. There was no treatment for high
blood pressure in the good old days.
They wouldn't have detected that, then?
They could detect it but couldn't control it — remember FDR. So
what's the use of bothering? They wouldn't have done anything
but talk about it. I met Bill in high school. It was also the
very first year we had a great crop of apricots; I knew
something about him from school. He was a nice person, a giant
of a fellow.
I asked him if he cared to come out and work in the fruit.
Well, it turned out he was desperate for a job. I would say
that he worked for us for at least four years, off and on, on
every job there was. My father thought he was fabulous, and he
thought my father was fabulous. Well, I never got along with
my father. But we didn't get into that. Bill and I were very
close friends, and he was my big, physical buddy.
And what a rich friendship, that you kept it for decades.
From '27 to
didn't come
'96. That's almost seventy years,
out with Bill, thank goodness.
My eliteness
What was Bill's last name?
Mills.
Bill Mills. And what happened to him?
Well, very nice things. We graduated together, and when I came
to Cal, he went to Richmond to a job in the Ford assembly
plant. I think they were just opening it up. There, he met a
local girl, got married. Her family finally cleared out,
saying, "We don't want to work on assembly lines," and they all
went up to Grass Valley, across the highway from Auburn. There
are two little towns there, and one of them, Grass Valley, is
the home of the Empire Gold Mine, an exciting landmark that you
30
can visit now. It's a state park. This is the place
associated with Filoli on the peninsula, and plays a part in
Wallace Stegner's Angle of Repose. They settled up there with
two kids, and he bought a big piece of land for near nothing.
He was in the television repair and sales business. When the
land suddenly skyrocketed in value he took up contracting, and,
every year, built a house. He became a prosperous builder,
built quality homes.
We'd meet at class reunions,
there.
He'd drive the biggest car
Crawford: This would be Napa High School reunions?
Blum: Napa High School.
Crawford: So you went to those?
Blum: A couple of them. It was really nice to see this kid making
it.
Crawford: He did very well.
Blum: Yes, and not the least bit boastful or a show-off or anything--
except for the car. He loved cars. He always did when he was
a kid and never had any. Didn't have a car until halfway
through high school. Then it was stolen by the dealer, who'd
never filed the license plates with the state. The company-
General Motors — repossessed the car, and all this money that he
put into it was gone because the dealer absconded with it.
Crawford: He couldn't trace it?
Blum: Not that, the dealer went to Brazil with everybody's money--
from hundreds of cars. That's a lot of bucks.
Over these years, I was sort of picked up at high school by
another group of people, also Catholic. The Smiths, just
lovely, lovely people. They had just moved to Napa. There
were three kids in the family: one in my class, an older sister
a year ahead, and a younger boy a couple years behind. The one
in my class was a personality kid--as different from me as you
could get-- just full of jokes, a character. He's still up
there. We went through school together; and, gathered around
him was this group of kids that we associated with. These two
sets of associates were very separate groups: Bill Mills and I
in one setting, these other people and I in another. I was
very close to those people too. The Smiths practically adopted
me when my family split up--I was the only child. My mother
31
had to have a hysterectomy for fibroids, and we had no money.
A wonderful Napa doctor who did surgery at St. Mary's in San
Francisco was our usual doctor. He said, "I'm not going to do
it, I'm going to have a better qualified doctor do it." He
paid for the hospital and the surgeon, and took the whole thing
on his back.
Crawford: This private doctor?
Blum: Yes, and so my mother went to work for him in his home. He had
little kids. She worked there for quite a few years. So the
Smith family, knowing that I was left on the farm with my
father—we didn't really fight; I was going my way and he was
going his way—they sort of practically adopted me. It's
interesting. These people who were so different, and accepted
everything, and God's authority, all but this one son who was
my classmate. He was really a rebellious rascal, in a quiet
way. I went to Cal. He went to Stanford and became an
engineer, the kind that explores for oil, and did so all over
the world—an interesting career. The father was a magnificent
stone mason, and ran the local business of making headstones.
Mrs. Smith was a tough, small woman, but very kindly. There I
was surrounded with different kinds of people— really not my
kind of people at all— but those are the people I got along
with so well.
Crawford:
In the year when I dropped out of college--! did that after
the first half a year, when engineering had fallen apart and I
was sitting there with no money, having spent all my savings--!
went back and worked for him part of the time, setting
headstones. That's a kind of brute labor. The rest of my
time, I worked on a prune dehydrator, and picked fruit.
By the time I got through high school, I started to grow a
bit. When I got there, I was fifteen and probably 5 '10" or
something. You asked me, was I tall. Well, at the first class
reunion, which was fifty years after we graduated from high
school, when my wife and I came in the door, many people were
already seated— we had driven up primarily to see Bill Mills
and his wife. We came on in, and my wife kept hearing, "that's
little Henry." [laughter)
But back to being an elitist. A message that I grew up
with was, "if other people think it's good, you'd better watch
it, it's probably crap." That certainly set the stage for
being isolated.
Well, that's what you had said. Your mother had taken you to
cultural things in San Francisco, and I'm sure many of those
32
children had not been exposed that way.
of a common grounding, was it?
It wasn't really much
Blum: No, and you get the habit of looking down your nose out of
self-protection because you can't compete for athletics, for
games. Nobody wants you on their team when it comes to a real
game. So in high school, what did I do? Joined the debating
team.
Crawford: Talk about that.
Blum: Well, it was interesting because the subject is picked by
somebody else. By happenstance, your team will get the
positive or the negative side of an issue, and that's what you
do. You don't come into it taking the side you want, you have
to perform on a clean table. You have a couple of weeks to
prepare for a debate. We would debate with other high schools.
I was relatively good at it, and just a wee bit nasty, just to
keep the folks in the audience happy. [laugher] Well, it's
not quite nastiness, but it's kind of making fun of the other
guy's arguments or logic, undermining their credibility.
Crawford: You don't mean demeaning?
Blum: Well, as I look back on it, I think that some of the comments
were just at that edge of taking a popular side of an issue and
then making a joke of it. I remember one of the debates was
about the chain store business: the chain store versus the mom
and pop. Well, my girlfriend in high school was the daughter
of a family with a mom and pop grocery. Her folks were very
pleasant, but kind of austere. They were really quite
religious, but not Catholics — Protestants of some sort. I
remember a crack that I made about the issue, that if we were
not going to allow the chain stores to come in—then we were
going to be stuck with these poor little places where they
weren't too keen on hand washing and sanitation. I knew that
household all too well. [laughs]
Crawford: You really knew what you were talking about.
Blum: But one is not supposed to say that kind of a thing. One is
supposed to talk about the economic aspects. And I suspect my
girl was sitting there and laughing. She came to Cal a year
after 1 did. The first book she wrote was reasonably
successful. She dumped me for a very handsome, lovely, big,
powerful Irish guy.
Crawford: On the basis of that debate?
33
Blum:
Crawford:
Blum:
Crawford:
Blum:
Crawford:
Blum:
Crawford :
Blum:
Crawford:
Blum:
Crawford;
Blum:
Oh, no, for some reason, she decided we were a very poor match;
and we were. I was not very keen about having a lot of kids.
She was going to raise as many as possible. Intellectually, we
had a lot of things in common, but in terms of practical
living, no. I was sort of on her trail for several years. In
that first book of hers, the heroine was her, the hero was part
me, part her husband, but they surely had lots of kids. They
were living up in New Monterey, you know--Steinbeck country,
Tortilla Flats. I had a chance to visit with them when I was
stationed at Fort Ord in 1941.
He was an artist and she was a writer?
Yes. He was really handsome--a powerful fellow.
Would their names be known?
I think so: Jean Ariss. She didn't write under her maiden
name, she took her husband's.
Well, let me ask you before we go there,
high school?
Were there mentors in
No. Some teachers did take hold, but I don't remember a person
in that role, although my English teacher and my chemistry
teacher were both impressive, and not just to me.
So these very strong f riendships--a couple of them—were really
what you held onto?
Interestingly enough, another one was a kid whose father was an
administrator at Napa State Hospital. We were quite close and
had a lot of interests in common. He too was not an athletic
person. He was more like me than almost anybody else I knew in
high school. He went to Stanford. I met him thirty years
later, here on the campus. He was visiting people that he
knew, who were also friends of mine. I hadn't realized that I
was going to meet him, but did. It was fun. He was a very
sweet person. He's since passed away, as I've learned.
What was his name?
Jeffries.
So several people went on to Stanford from your high school?
It was a class that really blossomed. The high school did not
have a strong tradition of sending people to college, and all
of a sudden with the arrival of a new superintendent, there
were college students bursting out all over, and particularly
into chemistry—there were a lot of people here in chemistry
from that high school.
Crawford: Was he a chemist?
Blum: No, but he brought in good teachers; and one of them, a Mr.
Buchanan, was a wonderful teacher; and everybody got enthused
about chemistry. We'd never heard of it before, but suddenly
everybody took chemistry because it was such fun. He was good,
technically. I was here at a dinner some years ago at the
chancellor's house, and a man who was once head of the
chemistry department here and then became a chancellor at
another one of the UC campuses was at the table where I was.
He asked me where I went to high school," and I said, "Napa."
He said, "Didn't you have a wonderful chemistry teacher?" This
was a professor in chemistry, here—world-famous too. I said,
"Yes, we did." He said, "I remember the man. He sent us
wonderful students." You kind of wonder, where were the
students before and after this teacher who induced so many
students to become chemists.
Crawford: That's extraordinary.
Blum: Yes. And here is the former dean of the school of chemistry,
aware that there was a great teacher out there because there
had been so many of his students here. There were Phi Betas,
and more Phi Betas; and one UCB valedictorian. All kinds of
good students from such heretofore barren Napa soil.
Crawford: All who came from a small class of sixty or so.
Blum: Yes, tiny, and for several years in a row. Even schools take
on characteristics; but you wonder: is it the teachers or is it
the school, or demographic changes?
Crawford: Were you close to this teacher?
Blum: Not personally close, but as a student, I just loved the class.
I said if I didn't become an engineer, I'd be a chemist.
Crawford: What else do you remember studying, and what made an
impression?
Blum: Well, a lot of English, a lot of literature. That's where I
goofed because if I hadn't done all that, I could have taken
typing. So I'm still crippled for lack of knowing how to type.
Crawford: One of the most important courses.
35
Blum: I know it, and nobody ever said, "Are you going to college?"
They took for granted I was going to college. I was not
encouraged to waste time on "commercial" courses. Stupid.
Although I also I never took Latin out of pig-headedness , so I
might not have taken typing even if encouraged to do so, being
an elitist.
Crawford: Latin was offered?
Blum: Greek and Latin. But I was emancipated from what was
apparently current. I did study French for three or four
years, in that way picking up a lot of language background.
The Depression Years
Crawford: Talk about the Depression.
Blum: I came to UC Berkeley in '31, and the farm went under in about
'32. It was really already under in '31. There was a mortgage
of five or six thousand dollars. The Petaluma book makes it
clear how it occurred. Every year you borrowed the money for
the eggs, the chicks, the feed, the whatever you bought. Then,
after so many months, you'd suddenly have this flood of
chickens or eggs or whatever, and you'd pay the debt off.
You lived that way all your life. When they had a couple
of bad years in Petaluma, and people couldn't buy the poultry,
the people suddenly had these unpayable mortgages. So farms
all over just folded. And ours did, similarly. But, in any
case, there was nothing to stay home for, either. I mean, you
could talk about taking care of the farm, it was pointless.
Who was going to turn on the pumps to irrigate the trees or the
vineyard when the crops couldn't be sold? Who was going to
raise and feed chickens when you couldn't sell them?
Crawford: Nobody had the wherewithal, did they?
Blum: Nobody had the wherewithal, and you couldn't get rid of
produce. We hit the Depression when we were into turkeys. We
were selling them, then, at cost. We would get--on the hoof
with all the feathers and every thing- -maybe thirty-two cents a
pound. You could survive. It wouldn't lose money. Once in a
long while--come Christmas or Thanksgiving- -you'd get forty-
eight cents. Incidentally, it's of interest to note that those
prices are not too different from the prices today.
36
Crawford: You're kidding?
Blum: Oh, no. If you buy turkeys around Christmas time or
Thanksgiving, you'll find the price is often not too different
from what I was used to in the twenties.
Crawford: So that was a good deal of money, then?
Blum: Yes, also evidence that farmers produce food at much lower cost
today.
Crawford: When you were getting it?
Blum: Yes. When we were getting it. The one market we had for heavy
chickens was Chinatown, San Francisco, because they wanted big,
beautiful, live birds. You know the current squabble in San
Francisco about live birds? Well, the Chinese were the only
people who were fussy enough to insist on having a good,
healthy, live bird when they bought it.
Crawford: Everybody else wanted them dressed?
Blum: Others didn't give a damn where they'd been or how they got
there. The Chinese were the only fussy customers we had. When
we were in the heavy chicken business, much of it went to
Chinatown for premium prices. They paid more, they were
willing to, they wanted good birds.
Crawford: For restaurants?
Blum: Not really. They were in the windows, and the people would
come in and pick one out for their own family.
Crawford: Did they come get them at the farm?
Blum: We delivered them live to Chinatown. That was the nicest kind
of arrangement we ever had: with the Chinese merchants who sold
live poultry. People came and picked them out. We had
beautiful birds, and people were willing to pay extra. It's
kind of funny because now live birds have become an issue, an
animal cruelty issue.
In any event, the farm went under, and so there wasn't any
use in talking about me staying on the farm; besides, I had no
intention of staying on the farm. I couldn't conceive of a
more idiotic way of making a living. You never knew whether
you were going to have a living or not. We did because my
father always went to work as a cabinet worker, and was so good
37
at it that he could always get a job. When the farm died, why
stay?
Crawford: Did he love fanning?
Blum: Not really. No, the point to the farming, and the point to the
Petaluma situation was very straightforward. It was kind of
socio-political. Where could you go and be your own boss — you
come from a city life; and with really no great money to
invest—but you can always borrow on the farm, and have a
mortgage going; have no bosses — that was critical-
Crawford: Independent?
Blum: Independent. And you didn't have to have much help. You
didn't have to boss anybody else. That was part of the credo,
be on your own.
Crawford: That's why not to choose a city existence?
Blum: Yes. So the whole Petaluma scene, in that sense, was familiar,
acceptable, because they mostly felt the same way. That was an
odd kind of socialism.
Crawford: Were they politically organized in any way?
Blum: My father spent his time organizing farmers, much of his spare
time. He helped the poultry producers of California found
Nulaid Eggs. He got people to sign up. It was a co-op. He
helped organize the prune growers- -the Sunsweet people, who've
become something other than a lovely farm-centered operation-
he helped found that crowd because we had prunes, you see, and
dried fruit. So he was into all these organizing things--.
Crawford: He was organizing?
Blum: Yes, and it was always at the co-op level, on his own time and
out of his own pocket. It wasn't to set up a big industry, it
was to allow the little guy to come out even.
Crawford: What did he do when the farm closed, then?
Blum: Since the people who foreclosed it couldn't do anything with
it, they said, "Well, stay there. Watch over it." So he
raised a little of this, and raised a little of that for a year
or two. Then he just cleared out. My mother and he had
separated, maybe four years before the ranch went under they
had separated. I started here, and she came and joined me
after a year or so.
38
Crawford: You had told me that she influenced your attitudes?
Blum: Well, she was an elitist, in a sense. There's no question
about that. I mean, she expected the most from me, she
expected the most from everybody, didn't see my father
producing the most of anything, and was very disgusted with
him.
Crawford: So, the political organizing was not her interest.
Blum: She didn't object to it, she approved of it in principle, but
it was nothing that she did. She took a back seat in all of
that. Her goals were—she wanted to see social justice, she
was willing to spend- -we spent money whenever we had it on all
sorts of good causes. She wanted a good world; but, for me,
she wasn't interested in organizing. She wanted me to be
something worthwhile, and it was really cultural, you know. So
I came here when I was fifteen and started Cal--.
I didn't really see any justification in my going back to
the farm. My father wasn't holding anything together. He
wasn't supporting my mother or me or anybody else. It was just
himself, it got to be that. He wasn't one of those that was on
the bum, he actually worked in orchards. He knew how to do it,
but that wasn't his forte. He worked as a millwright in the
timber business. He worked in shipyards, doing ship-building
kind of jobs. There weren't many jobs in the early thirties.
It was a long, barren period. He kept going for about fifteen
years, I guess. He would go from one thing to the next, and
particularly because of his carpenter-type skills, he could
always find something; and he worked cheaply. He did what he
could.
Crawford: And he kept organizing?
Blum: No. Something happened to him during these years and he lost
all interest in everything political and cultural. He stopped
reading. He didn't bother about organizing or politics, he
just kept alive.
Crawford: Was he pleased when you came to the university?
Blum: I don't know that I ever heard a word from him on the subject.
He wasn't actively opposed. It was clear that he thought maybe
I should stay on the farm, but there was nothing to stay on.
So, we really parted company pretty thoroughly. I hated him.
He was vicious to my mother from time to time. I didn't
hesitate to threaten to shoot him, once. I thought that would
be a good move. It wouldn't have been, I guess, but--.
39
Crawford: Were you serious?
Blum: Oh, yes.
Crawford: You were defending your mother, I suppose.
Blum: Yes. I wouldn't go for that sort of thing. I had a lot of
guns, having lived on a farm, went hunting.
Crawford: Did you hunt and fish together—the two of you?
Blum: Never. He had no interest in that.
Crawford: He was not an outdoorsman, I guess.
Blum: Not really. He worked on the farm, and loved being outdoors,
but in regard to sport, no. None of that. He wouldn't object
to my going deer hunting, or this hunting, or that hunting, or
fishing; but he never did.
Crawford: Well, let's talk about your piano studies. We need to go back
to that because I know you were serious about music.
Blum: Well, I really was, and I wasn't. I had a wonderful teacher in
the town. Lessons also had to be fitted in on Saturdays.
Crawford: How did you get into town?
Blum: There was a car.
Crawford: You had a car? And you devoted Saturdays to all these
different things? The library--.
Blum: All these things. So while my father was here and there and
elsewhere doing the bulk of the shopping--my mother would go
once a month, while he and I would go every Saturday. So I'd
go get lessons. It was an hour. It cost a dollar an hour.
Crawford: Do you remember a name?
Blum: Yes. Miss Leah Grigsby. There was a Mrs. and a Miss, and I
had Miss. Mrs. was not related to Miss, and they were always
competing, which was kind of funny. Each had a large
following. I loved my teacher because she was kindly. Some
people loved the other lady because she was so stern and
disciplined. I didn't go for that at all. My teacher would
have a hyacinth picked, or something, sitting on the piano that
you could smell. She was a very human human being, and she
would buy me presents of sheet music. She had two lovely
uprights. So, on occasion, we'd both play. I was technically
rather proficient, but I'm not a musician. I mean, I can't
play without music. I could memorize something but it was a
grueling investment.
Crawford: Did you practice?
Blum: About an hour a day. There wasn't any let-up on that. My
mother saw to that. [laughs] I don't know that I hated her
for it, but I just didn't enjoy it. Everybody else was out
playing, and at prime time, I had to go in the house and
practice. I did well enough. After four months' lessons I
went on to recital. My teacher had a big recital, and I played
a tiny piano part of "II Trovatore."
Crawford: That's ambitious.
Blum: I sat there playing the gypsy chorus. It's a couple of notes
up and a couple notes down; but there I was, about so big.
Crawford: How old were you when you started?
Blum: I suppose four or five. So that was a great success,
tantalized everybody into thinking I was going to be a
musician. At four months it looked good. I stayed with it for
seven or eight years until we went broke. Part of the ritual
in fruit season was a box of cherries one week, one week a box
of apples, another a box of apricots, a box of grapes for my
teacher.
Crawford: Your teacher?
Blum: My piano teacher always got something. We liked giving things
to her. I got to high school in '27. The Depression was
starting to be visible. We didn't have any money anymore. So
I stopped taking the lessons, went through high school, and
never touched the piano.
I started Cal in '31, and then at the end of the first
semester I took a year off because I was broke, all my savings
were gone, and I wasn't doing very well. I'll tell you about
that experience. So I stayed out a year; and, in that year, I
just picked fruit, got jobs here and there, worked on a
dehydrator, packing boxes, set tombstones. I was getting
pretty husky then. I've shrivelled a lot since then.
Music Studies and Cultural Exposure
Crawford: Were you tall as a very young person?
Blum: No, tiny, tiny. I got to be about 6 "2", ultimately. In my
year out of high school I did all kinds of work around. In my
spare time, I ran. I built some gymnastic equipment and used
that for an hour a day, and I practiced the piano three or four
hours a day. It had two broken strings, which we couldn't
afford to fix.
Crawford: This was your upright?
Blum: Yes. I got quite proficient. I finally bought a lot of good
music, and I studied the Beethoven concertos. Real music never
deserted me--I mean, the technical proficiency. I didn't
practice for years at a time, didn't touch a piano for years in
medical school. But my mother got her money's worth out of it.
She knew that I could play; and ultimately, when I first got to
be a health officer we bought a new house and we built her an
apartment as part of it. She got to hear me play on a good
piano after all those years.
Crawford: That's great. She must have been very pleased about that.
Blum: I don't remember that she ever said anything, but I'm sure she
was .
When I was going to Cal, I lived in a terrible boarding
house across from the Durant Hotel. The head of the music
department at Mills College lived in that hotel. It seems to
me her name was Mrs. Swayze. She heard me playing, and she
came over, knocked on the door and invited me to come and
practice in her apartment. She had a beautiful, big Steinway
right there. She had a large suite of rooms, and she made her
home there. So, I did that once in a while. It was better
than that terrible piano at the boarding house, and no one to
heckle me for playing classics. Those were some of the few
good moments that I got out of it. There also was a wonderful
piano on the campus in Stevens Hall. It was a gorgeous
Steinway: unusual colored wood, a wonderful tone. I used to go
up there on Sunday mornings. With nobody around you could
play. Finally, it became popular. There were always groups
meeting there, but my first year here in '31 I did play on it.
Crawford: You mentioned the blue books, the little blue books.
42
Blum:
Oh, that was an interesting part of my life on the farm, yes.
Those were a nickel and a dime a piece, and in that Petaluma
Crawford:
Blum:
Crawford:
Blum:
Crawford:
Blum:
Crawford:
Blum:
Crawford;
book they discuss them. I mean,
book after I talked to you.)
it's all there. (I got that
Maybe you had just heard of it when we talked because I made a
note of it, but you hadn't seen it.
I don't know, a friend just gave it to me. In any event, I
remember the blue books because we had stacks of them in the
basement. We had a room down there which was built as a
sleeping room. We used to give hoboes a ride when my father
would drive along. Most of the hoboes in those days were folks
that came out of the skilled trades — there was the IWW.
Where did you find them?
Oh, on the road when traveling to town or to Sonoma or to
wherever we were going, we'd see these people. They would be
walking along with a small bundle. You'd stop and ask them if
they wanted a ride, wanted to go anywhere. Often enough, these
people had work experience in common with my father: they were
mechanics, woodworkers, one thing or another. So some of them
would say, "Yes, I wouldn't mind staying on the farm for a
while." And my father would say, "Well, stay for a while, and
if you want to work, I'll pay you, if there's work to do," and
there often was for brief periods.
We used to hire some day laborers to do this and do that,
particularly if my father was doing cabinet work. So some of
these people lived in this room, and that's where the blue
books were. Sometimes I'd get into conversations with them
about these books. The blue books were all excerpts from the
world's famous literature: philosophic, political, and the
romantic literature. Although I had plenty of library books,
these books were kind of a kick because they were so diverse,
you could cover a lot of territory—in a few minutes one could
see what an author had to say from a key excerpt.
Excerpts? They were excerpts?
Excerpts. Yes.
Who published those?
The word Haldeman comes to mind, but I'm not sure.
Haldeman. But your father collected those, did he?
Blum: Well, he went to the city and to meetings, and if he saw one,
it was no more than a nickel or a dime, the price of a candy
bar or a package of peanuts. In Petaluma, the blue books were
evident as a very common institution. But our big affair--my
mother and I--was to go to the city and take in something that
was big time culturally.
Crawford: Do your remember what you saw?
Blum: Oh, yes. Caruso--.
Crawford: Oh, you heard Caruso?
Blum: Yes. Geraldine Farrar, Ezio Pinza, Chaliapin.
Crawford: Where were they singing?
Blum: The Civic Auditorium. All the great performers. One thing we
did have, and nobody else in our neighborhood had, was a good
phonograph. We had all the classical records that cost three
dollars if they were on one side, and four or five dollars if
they were on both sides.
Crawford: That's a vast amount.
Blum: In fact, a vast amount. So there was everybody: Gallicurci,
Heifetz, Rubenstein, all the great singers and
instrumentalists. A friend of mine, without knowing about this
part of my existence at all—he's a collector — has brought me
several volumes about all the old opera performances and the
singers; the pictures and the events.
Crawford: And the recordings?
Blum: No, I have some of the recordings left over from the farm, but
they're so grim. I mean, who can waste the time that's
involved? Every three minutes you've got to change the record;
and they're technically terrible. Well, we've still got a box
of them.
Crawford: Seventy-eights?
Blum: Seventy-eights, but I don't listen to them. Five years ago I
got rid of the last device that we had that would even play
them. Ordinary players don't do seventy-eights. Well, I
finally got rid of it. It failed, and I just gave it up. But
I remember, those were the days when Gigli was a young man, and
Schipa was a young man. I go through these old books about
opera now, and relive it.
see their faces.
You sort of hear these people as you
Crawford: They don't come like that anymore.
Blum: They do and they don't. There are fabulous voices now, just
fabulous; but those were hard times. You could go to the opera
house and hear them once in a while, and then the seventy-
eights helped you relive the real events.
Crawford: Coming to San Francisco was a day-long visit, wasn't it?
Blum: Yes. We'd be there for a couple of days, and we stayed with a
woman that my mother knew from Russia. She lived across the
street from Mission Dolores. It's a beautiful spot, really.
Lo and behold, my neighbor, now—for the last thirty years-
turns out to be the niece of that lovely old lady.
II COMING TO UC BERKELEY: UNDERGRADUATE STUDIES, 1931-1937
From Engineering to Chemistry
Crawford:
Blum:
Crawford:
Blum:
Crawford;
Blum:
What a coincidence,
be an engineer?
Well, by now you decided you were going to
An engineer, and that's how I got to Berkeley. The university
made a few exceptions on my account because my grades were not
very good. I only got good grades when I was minded to. The
principal vouched for me. The high school had a bad
reputation, then. The university didn't want to take students
from Napa High, but it had a new superintendent—or principal--
and he was a fuss-budget, and he really turned the school
around. I was one of his new products even though my grades
weren't so hot. So I got in. The first thing I did here was
flunk Subject A. I hadn't done a lot of writing, actually, but
was thought to be pretty good at it. That was kind of a shock.
In high school?
Yes. In high school. I was sort of a teacher's pet there,
too, because I knew stuff that nobody else ever heard of; when
you enter the world of literature, there's a lot of things you
know. I had a wonderful English teacher, her name was Blume of
all things, a tiny little darling woman whom I saw in recent
years and she was still a tiny little darling woman who
remembered me.
From Napa?
She actually was from Berkeley, originally, as it turned out.
She went there to teach school when she graduated UCB. She
wasn't much older than we were, and a marvelous teacher, so I
had a great time with that. Well, I came to the university,
here, and the first thing I did was flunk Subject A.
not too highly thought of.
That ' s
46
Crawford:
Blum:
On my first day of school, I went over to engineering,
that's where I was going to be, and I went to take Civil
Engineering 1A. They had a brand new building called the
Engineering Building—that nice marble-looking building—but in
the catalogues that we were given, the instructions showed all
the rooms for the engineering classes in a building that had
been shut down, and they hadn't modified the books. So I went
up to old North Hall, which used to be, I think, where the
engineers were. It was an old building that was just on the
verge of being torn down, and it was locked up.
I looked around, and finally asked some people, and they
said, "Oh, well, I think engineering's right over there." So I
got there about half an hour late— with three others — and it
was our first day of school. In those days you didn't pre-sign
up. They had a sign-up in terms of paperwork, but you enrolled
in class the first day of school.
I got there and they said, "Well, we're very sorry. There
are no more transits— the survey instrument that you're going
to use in the course— there are no more measuring tapes, and
there are no more levels, and there are no more desks." This
was '31, and being an engineer was serious business for a lot
of people. Well, they thought maybe somebody would drop out.
So the four of us— which is the size of a work group— used
to go up in the hillsides up where Bowles Hall is now; there
used to be cattle there. We "measured" from one cow flop to
the next, you know. This was the pasture; but these other
people had tools with which to do the measurements.
So we measured with our feet. It was a joke, a bad joke.
We'd come in and we'd get an F— or a zero. Just like we'd done
a bad job. Then we sat in class and listened to the comments,
and for four weeks we got zeroes. It was clear that nobody was
dropping, it was time to quit because we weren't going to get
any equipment and we were going to fail in the basic course of
our chosen career, perhaps get flunked out of Cal as well.
Find a new major.
Right. This was Cal, very impersonal, nobody gave a damn. So
I went up to the professor. He was a very handsome, powerful-
looking middle-aged man by the name of Wiskocil. I said, "I'm
going to have to drop." He said, "Yes. We're just glad to see
you go." I was fifteen years old. That was the end of my
career as an engineer.
Crawford: What an attitude.
47
Blum: So, I switched to chemistry.
II
Blum: Thinking back, I had had a wonderful chemistry teacher in high
school. I took physics, mechanical drawing, art--which was
truly an experience. It took a year for me to draw one tulip,
and it didn't look like too much. [laughter]
Crawford: You weren't cut out to be draftsman?
Blum: No. So, leaving engineering probably worked out for the
better. So I started off, but now I had a gap of four units,
and it was too late to make it up. Of course, one can make it
up in due time. Then I forgot my Subject A class. I got so
busy with chemistry—it involved labs three times a week, and
I'd stay there as long as I could, I was having a good time--
and that's when I was supposed to be taking the Subject A
course at four o'clock three days a week.
Crawford: That was English?
Blum: English composition, yes. So I woke up about the end of the
semester, and I trotted over there to the last Subject A
class, and the teacher said, "I remember your name. You signed
up. What happened to you?" I said, "I forgot about it. I've
been in these labs--these chem. labs--and I suddenly
remembered." "Well," she said, "I'll tell you what, you can
take our final exam, and we'll see how you do. You can always
take it over again next year." So I took it, and I got an A in
it, don't ask me why.
Crawford: Reading?
Blum: It was writing, not reading. But I had forgotten about it
because I was doing chemistry. So the chemistry was pleasant,
and a lot of hometown kids were there, a very industrious crew,
mostly sober with a few interesting exceptions. Alcoholism was
rampant in those days, even amongst chemists.
Crawford: Now you're talking about student life, and drinking among
students?
Blum: Yes. That kind of steered me away from some of those groups;
but we didn't have always the best faculty examples. I
remember, we had two Scotchmen on successive lectures, famous
men—one of whom I couldn't enjoy. He was such a prissy
character. The other one I just loved. He was a hard-drinking
guy.
Crawford: Real Scots?
Blum: Real Scots, oh yes, red hair, everything. We came in the
classroom one morning, and the first professor- -the fussy one
who never smiled or anything, just steely-eyed, all business,
probably a nice guy--and we all smelled gas. He said, "There
are a lot of metal plates here, and some of you have metal
cleats on your shoes. Take it easy, let's not have an
explosion." So we sat through our class. The next Scotchman
comes in and [makes sniffing sound] he said, "I smell gas," and
he gets out his cigarette lighter and he goes around looking
for the leak. [laughter] These are two separate worlds. The
second man, of course, was the man who liked to drink. He was
truly an imaginative, lovely human being. I did some research
with him in later years.
Crawford: What was his name?
Blum: Gerald Branch—a great guy. The story went that he'd fallen
into the Strawberry swimming pool more than once. Any event,
it was a nice educational experience, and Cal was probably the
elite chemistry school in the United States.
Crawford: You were close to these professors, then, as an undergraduate?
Blum: Fairly close; if you were a good student, and they got to know
you, it was just that simple. I was good enough. I wasn't as
good as the best, but I was pretty good. I started realizing,
though, that there were some that were so much better. Truly,
their minds were good, good, good. I didn't want to be a
second-rate chemist; and that's what I would be. Most of my
classmates who did about as well as I did ended up doing tests
for the oil companies out here. I didn't see that as a career.
So I started looking around for some applications in biology in
particular. That seemed to make sense to me. I took
bacteriology and just loved it and met some wonderful people,
like the recent dean of the graduate school, Sanford Elberg.
He was a T.A. in my student days. We had a great time. I
was making a point then, of getting the best grade in the class
by knowing the most. It was kind of satisfying. If you're
going to do it, do it right, know all the material. Then we
went on to more advanced courses, and the advanced course was
eight units. We lived in this lab because there was a lot of
lab work. We were there day and night, practically. I loved
it. Tonight I'll meet with a nephew of the student who was my
lab partner in that course.
Crawford: So you've stayed in touch?
Blum:
Crawford :
Blum:
Yes. Sort of long-range, but we did. I met my wife there as
well. Her older sister was a bacteriologist and had a close
friend working on her Ph.D. in bacteriology who shared the lab
with us at night as we worked on our experiments. Marian and
this friend of her sister's were both in a botany course and
studied together in the lab every few nights.
Was she in the sciences?
No, she was in social work, an undergrad program,
freshman and I was a senior.
She was a
Perry R. Stout and Daniel Arnon: Mentors
Blum:
Crawford :
Blum:
Crawford:
Blum:
Crawford;
Blum:
In that high-powered bacteriology course were all the future
hot-shot biologists. I made up my mind that I would do better
than anybody else — and did—for which one sort of gets marked
out. But this is no longer grammar school. Now you're
amounting to something, and to beat out all the folks who had
it made — for instance, one of the professors of zoology who
then was a doctoral student; and I wasn't a doctoral student,
but I just kept getting better results than he did. It made me
feel good because he was the anointed one there. I discovered
that I was good at something, but it wasn't chemistry.
However, I later went on to work for a group of chemists here,
some famous ones, in plant nutrition. One was Daniel Arnon.
He came close to getting a Nobel.
What was Arnon 's field?
He was a chlorophyll metabolism expert, an expatriate from
Poland. Then, I worked for a fantastically wonderful guy-
Perry R. Stout, who became a big wheel at UC Davis in due time.
These people did the most interesting experiments; and there I
was, the hired hand as a chemist, fifty cents an hour. You
day. That's how I saved
might work eighteen to twenty hours a
money to get to medical school.
You were working on their projects?
On their projects, yes.
As a research assistant?
Assistant. Much of it was, "Hey, run these potassiums, run
these sodiums, go feed the tomatoes, do this, do that." So you
50
were a gopher. But on the other hand, if you had brains enough
to cook something up, you might be allowed to do it; but that
wasn't what you were there for. Stout—particularly Stout — did
the most fantastic experiments; and he only belatedly got
credit for them because his experiments were seen as "too
easy." I'll never forget that.
Crawford: What do you mean?
Blum: Well, he was trying to get a Ph.D., while he ran the storeroom
for the Department of Plant Nutrition, for which he got about
one hundred and ten dollars a month. Then he'd do all this
stuff. He was the man who discovered what happened to the
added phosphates in some phosphate-depleted soils. This was a
great mystery to everybody. The farmers pumped on the
phosphate and the trees blossomed. But the next year, the
trees declined. On an analysis of the soil, "It's there, but
why don't the trees get it?" Well, he figured out just exactly
what the crystalline structure of the soil was, and that
particular soil absorbed the phosphate into a new crystalline
format where it became unavailable to the trees.
Crawford: So, after initial application, it wasn't there?
Blum: It wasn't there for the trees to get it. It had been a great
mystery. Perry R. did all this work with crystallography and
x-ray diffraction patterns. He had taught himself mineralogy.
He was no mineralogist, he was an agricultural chemist. I'll
never forget, he sent away to the USDA for soil specimens- -or
mineral specimens— because he was learning how to do
diffraction patterns on the x-ray.
He established the diffraction patterns of the well-known
minerals that the USDA had sent to him. He got the diffraction
patterns, but one of them doesn't come out—one of these from
the USDA— all labelled and everything. So he does it again.
He assumes he may have miscalculated or mislabelled that
sample. Again, it came out with this wrong pattern. So he
figured out what it really was, and he wrote back to the USDA
saying, "You know, the sample you sent me as thus-and-so is
really not thus-and-so, but is something else with the
structure I've established." He became a hero overnight. USDA
had never been able to identify what that specimen was, and
they told him that. He was using relatively new technology— x-
ray diffraction patterns, you see— and they were using
something else. Well, he went around the world before it was
over, explaining this way of doing business and this wonderful
experiment. He just did one exciting thing after another.
51
Crawford: He was a Ph.D. candidate?
Blum: Candidate. He never got a Ph.D. because his committee would
sit there and say, "Well, you only worked on that for two
months, you can't get a Ph.D." So, he went from one
spectacular thing to the other, and he never spent more than a
couple of months doing them. True, he'd spend maybe six months
or a year thinking about it, but when he hit the lab, it was
all streamlined with all the options laid out. He did work
with radioactive material that was then commencing to be "the
thing," and Perry R. was finding new isotopes every day. He
and I would work on them, and he was just an absolute genius.
He'd say, "Well, if it is in the filtrate, it's this; and if
it's in the residue, it's that." I hardly kept up with him.
I'm just reading, now, the life of Lisa Meitner, the famous
German physicist who worked in the area of radioactivity, and
had exactly the same sort of responses to her findings. Here
Perry R. Stout was banging it all out, and he's not even a
physicist.
That further convinced me that I didn't want to be a
chemist. I told him when I left, "Perry R. , you work one hour
a day extra, and that will take care of everything I ever would
have contributed." I mean, that's the relationship: about 1:8
in terms of capacity.
I worked with him a lot. We used to go up all through the
Sutter bypass, that floods each spring. He was a consultant.
He'd make one major trip a year. We'd get in his old car, go
up there and take soil specimens and water specimens. From our
analyses of the specimens he'd tell the farmers what to put on
their crops, how much to irrigate, what to do, what not to do.
I would do all the analyses here; but he was the one who
figured out what they should do about their crops, each of
which had different needs.
That was a marvelous experience with a real scientist.
Then, when the war came along, I knew that he was in D.C. I
was stationed nearby in Baltimore. So I went over to see him.
He was in the old Bureau of Standards Building; and I came up,
and I was in uniform. The marine guard there said, "What can I
do for you?" I said, "I want to see Perry R. Stout." "Oh,
fine," he said, "just wait a minute." He disappeared for a few
minutes, and there comes Perry R. Stout. He's a great big man,
and he looks at me, and he says, "How did you get in here?" I
said, "I told the guard that I wanted to see you." He said,
"That same guard—he kept the British Radar Scientific
Delegation waiting for a week before he would even tell them
52
that I was here." And what is he? He's the head of all the
radar research in the world, exclusive of the German efforts.
When they hired him—he still didn't have his Ph.D., but
somebody knew that he'd done his x-ray diffraction work, he'd
built radar-type equipment, he'd built geiger counters, pH
meters. He just made these things in passing because he couldn't
afford them or they weren't available and he needed them.
Scientists had heard about him and shipped him to Harvard,
where the radar program was starting. On his first day there-
he's a big burly guy--he dropped the one piece of radar
equipment they had and broke it to smithereens; and they just
lost their minds. He said, "Look, just relax. I'll put it
together by morning. Just don't wear yourself out." And he
did. Well, they didn't even know how to put it together after
he put it together.
In short order he became the head of all radar research for
the Allies. They moved him to the Bureau of Standards and gave
him this building for a place to work, but he's still earning a
hundred and forty dollars a month because they had a deal with
universities that they wouldn't pay any more than the person
was getting when he was drafted. This is the University of
California at Berkeley at its best. He couldn't make his Ph.D.
in about five attempts, each of which brought him world
recognition.
Crawford: Would that happen today?
Blum: I suspect that it might. But the armed forces told the
university, "We're going to pay him what we think he has to
have. As the head man here, he's going to get the head pay,
whether you like it or not, whether we have an agreement or
not." So he earned a decent salary for the first time in his
life. We went to his house and had a drink. It was quite
something. A couple of kids — three kids — and living on nothing
all this while. He didn't much care. He was a real scientist.
Well, the university figured the only way out of that
embarrassment was to give him his Ph.D., and they did.
Crawford: Oh, so they did?
Blum: They did. They cooked up something. They gave him a Ph.D. on
one of the studies that he was already famous for. I remember,
when he flunked one of his doctoral exams- -he flunked it- -well,
the real point was that he hadn't spent enough time on
conquering the phosphate project. I remember Dr. Greenberg,
the great biochemist, had flunked him ostensibly because he
53
Crawford :
Blum:
Crawford:
Blum:
Crawford:
Blum:
Crawford :
Blum:
Crawford:
Blum:
hadn't memorized the structures of the amino acids. Here, the
next day, I'm working; and here's Greenberg sitting at Perry
R.'s desk saying, "Would you teach me how to do these x-ray
diffraction patterns so I can do my work?" Can you imagine the
son of a bitch? He had really flunked Perry R. because he made
important research look too easy.
It's pretty surprising.
I knew the professor because I had taken biochemistry, and he
was one of the nicer guys. But he flunked Perry R., and then
wanted Perry R. to teach him how to do his own work.
Maybe a little envy? Sounds like it.
A little something. It was pretty damned odd, yet not really
unusual. Other examples come to mind.
What happened to Perry R.?
Perry R. became famous, of course. He ended up in Davis as one
of the department heads. He died there—prematurely, I'm
afraid.
And how about Arnon?
Arnon just died about two years ago.
Never got his Nobel?
One
Didn't get his Nobel, but had a tremendous funeral affair,
of his daughters was one of my favorite health planning
students. I first knew her when she was a baby when I worked
for her father, but years later she came through public health
and was one of my students in health planning. An interesting
woman who has gone out to Santa Fe, and has lived there ever
since, didn't want to stay here. She has a brother who's a
well-known doctor, from Stanford. Kids scattered all over the
world; some of them living in England.
I can't resist telling you about Nancy. In the week before
her graduation she insisted I join her for a picnic lunch at
the Haas Strawberry Pool on campus. She would take us in her
father's car and bring the picnic. When we got there she had a
swimming suit and towel for me so I could go swimming and take
a sun bath. She confessed to subterfuge, she felt I worked
much too hard, was getting pale, and she wanted me to relax for
a couple of hours at least. She had to study finals and would
be back for me, and I couldn't cheat on the rest because she
was taking the car.
Crawford: They were sort of mentors for you then, the two of them when
you were an undergraduate?
Blum: Oh, yes. These were true scientists and fine persons, yes.
Crawford: And they inspired you to go on with medicine?
Blum: Not really. Oh, no. We never mentioned medicine.
Crawford: Thought you'd be a scientist?
Blum: Yes, a scientist, but my observation, particularly where it
concerned Stout, was that, "I'm just wasting everybody's time.
This man sees so much better, so much faster. I'm just going
to waste a salary and a spot if I stayed in his field."
Choosing a Career
[Interview 2: January 28, 1997]
Blum: I told you that at Cal, I was fishing for a career that would
use my chemistry; and one of the things I found was the wine
curriculum, because we had a vineyard, you see. I took all the
courses on campus for that. That was in about my third year,
when I'd done basic bacteriology. I had a good time there, as
I was trying to get more applied. I looked into the winemaking
business, and that was kind of fun. But just like being a
chemist in an oil plant, you do a thousand tests every week.
Forget it.
Crawford: You didn't see yourself as a vineyard owner?
Blum: Oh, no. Then I took all the biochemistry courses. Finally, I
took a course in pharmacology. I said, "Here we go. This is
how I'm going to get into research and use my chemistry. This
is going to be it." I was already going with my wife and it
seemed okay to her.
When I graduated from chemistry with honors and was
therefore offered a job at Shell Chemical where I discovered
barrel-rollers were paid more than good chemists, I said to
Marian, "Let's go over and look into the pharmacology program
at UCSF. It's a doctoral program, and that should be really
55
Crawford:
Blum:
Crawford:
Blum:
Crawford:
Blum:
Crawford:
Blum:
fun." We went over there, and the professor who ran the
program sat us down and explained that I'd be lucky to survive
such tough studies and the competition from medical students in
the basic courses.
This must have been during your senior year?
Just at the end, yes.
And who was he?
Oh, he was a great man. He was a dean once at a medical
school, Chauncey Leake: a big faker.
How do you mean that?
Well, he said to us--as we were sitting there, out in the sun
in San Francisco--"! don't know that you can make it. You see,
you've got to take the first two years in courses of the
medical school, and I don't know that you can get through. But
sure, we'd like to have you. You have a good background in
chemistry and biochemistry. Now you have to take all the
courses that make up the first two years of medical school."
It turns out that to take them in medical school will cost
seventy-five dollars a semester; taking them as a Ph.D.
student, in those days, cost twenty-five dollars a semester.
My wife got very upset with this professor because he repeated
several times that he didn't know whether I could make it or
not, getting through the equivalent of the first two years of
medical school in competition with the medical students.
Why? You were head of your class.
Well, but neither he nor I knew that then, that was yet to
come. We sat and thought about it. If you take the first two
years in medical school, you can go on to complete your M.D. if
you want to; or you can always go back to pharmacology. If you
take the same course work on the Ph.D. track, you can never use
it to complete medical school because you weren't enrolled in
medical school. Written into state law by turf-oriented M.D.s
was the fact that you had to take these courses as a student
registered in a bona fide medical school. We thought about it
for the time it took us to get home. I said, "The hell with
that. I'll get into medical school, and I can always go back
to pharmacology if I don't want to complete the M.D."
Crawford:
But you can't go the other way?
56
Blum: You can't go the other way, and the difference in cost is only
two hundred dollars. Well, there was one other difference: to
go to medical school, I had to have Shakespeare, zoology, and
embryology as prerequisites. I said, "Okay. I'll get the
money, so I'll go on working in gardening and chemistry—do
whatever I can—and I'll make up these courses, get them done
within the next year, and then I'll apply." So I only applied
to one school- -UCSF. I didn't have the money or the vision or
the interest in going elsewhere. My wife still wasn't done
with college here in Berkeley, anyway. So, that's what I did,
and I got in as soon as I applied in 1938.
Crawford: Did you apply other places besides UCSF?
Blum: No. There was no point to applying elsewhere to medical
school. I didn't have any money. I had about a thousand
dollars in the bank saved up from all the odd jobs. With
tuition being rather cheap at UCSF--it was seventy-five dollars
a semester for two semesters a year—you knew that you could
get by. My wife was still in school, she was still an
undergrad, supported herself. So we knew we could get by for a
year. UCSF made you sign a statement that said you had at
least three thousand dollars available. I didn't, so I had to
go get my father's signature. He was still up in the Napa
Valley, and I got his signature. He didn't much give a damn
one way or another. He thought I was crazy but he felt under
no promise to help me, nor did he have any means even if he
wanted to.
Crawford: He didn't think much of that choice?
Blum: No, and I'd never thought of medical school before.
57
III UNIVERSITY OF CALIFORNIA MEDICAL SCHOOL: 1938-1942
Happy Jack: Starting Medical School and Finding Housing
Blum: It took me a year to do the extra requirements, but that's how
I had the time to earn the money to go to school. That was not
a struggle. I was young, so I had those extra years. I made a
lot of nice friends taking these courses. Some of them are
still around here in the sciences.
Crawford: People are still in those departments?
Blum: Oh, yes.
Our first day in medical school was in anatomy. We
received a sixty-pound oak box made in San Quentin that
contained a five-pound human skeleton. This had to be taken
home as it could not remain on the laboratory premises. I got
a ride for me and my skeleton, but a block from campus there
was our tiny classmate Bertha bogged down with about a mile
more to go with her box. We got her home, but I'm still not
free of that memory of my medical school's concern for the
welfare of its students.
In the next twenty-four hours, we had chosen partners, four
of us to a cadaver. In spite of all that one hears about the
trauma to medical students that comes from dismembering a dead
person, our trauma came suddenly and repeatedly from the
faculty dismembering us. By noon of that second day, we had
our first taste of good teaching relationships. Our
instructor, who was best known as "Happy Jack," summoned us to
the front of the lab, sitting on our stools, and began to quiz
us on our assignment that we had more or less begun.
As he settled himself to the joys of intellectual sadism,
he looked around and saw one of us who had facial paralysis and
a wry paralytic smirk as a result of a birth injury. This so
58
demoralized Happy Jack, who didn't believe that anyone should
be smirking as he was about to lash us into shape, that he
snarled, "Wipe that stupid smile off your face when I'm
lecturing."
Our partner in medical school couldn't wipe his paralysis
off; he was embarrassed at being picked on for his disability,
and as I got to know him for what a kindly person he was , his
embarrassment was probably mostly for our instructor, who was
such a pitiful physician that he couldn't even recognize a
common birth injury. Happy Jack lived up to his nickname and
committed suicide a year later.
Our next hurdle came in histology next afternoon. The man
in charge was competent but apparently somewhat resentful of
only being number two in the hierarchy. He made us feel right
at home by disapproving of most of the microscopes which we had
to and did purchase on our own. Since they couldn't be
inspected prior to beginning classes, it was a bit
disheartening to find out that we couldn't proceed to do the
course work, which was 90 percent microscopy. But few of us
could afford another scope. Mine was an unused although
secondhand one that did a good job. An earlier admittee had
gotten about this far on his medical career, thought better of
it, or was plain intimidated, and sold his investment in
medical school. No one offered to help us so all of us fiddled
around, cleaned our scopes, and went on with our assignments
with some trepidation, but the instructors looked through our
scopes after all, and we all survived. These events made for a
most enjoyable entry into a medical career, one not to be
forgotten, although often suppressed as each of us came to
enjoy the benefits of being an M.D.
I had a most disquieting few minutes about two nights after
we had taken our finals. Marian and I were to be married the
day before Christmas and her sister came to stay with her for a
few days before the marriage in our newly rented apartment.
Marian's sister was an old friend of our professor of histology
and had arranged to meet her at our apartment, unbeknownst to
me. I got there from work and was astounded to see one of my
key professors there. This professor was presumably a very
stern woman, not unfriendly, but all business. I wondered,
"What could she be doing at our apartment, what could be
wrong?" As she learned of my impending marriage she said, "I
have a present for you. You're sharing first place in your
class in medical school."
Two days later we took the streetcar to the Hall of Justice
and had a most unromantic ceremony. Then we went to Richmond
59
to see Bill Mills, his wife, and new baby. To finish the
wedding day off, Marian's father took us to dinner.
Marian still begrudges the streetcar and the ceremony at
the Hall of Justice.
Crawford: The Hall of Justice in San Francisco?
Blum: No, Oakland. We still lived on this side. The first year of
medical school was in Berkeley. In the Life Sciences Building.
We did anatomy, histology, biochemistry, all those courses
here. The first year was moved in later years to San
Francisco. So that was a good start, and there were no regrets
at that point, except my wife's having to take the streetcar to
get married.
Chauncey Leake and Pharmacology
Blum: In the course of those first two years in medical school, we
also had to take a course called pharmacology, taught by this
great man, Leake, who had told me I'd probably never make it.
I took pharmacology, and I'll never forget this professor.
He was a real blow-hard, a good storyteller. The first thing
he told us was to go out and buy a book that he had written
with a newspaper man called Medicine: Magic in a Bottle. This
was our textbook in pharmacology. Well, it was a fun book.
But, at the same time, the most beautiful of all medical
textbooks came on the market, Goodman and Oilman on
pharmacology, still a classic, how one should really write
textbooks. I heard about it from somebody and went down and
bought it. In those days, it cost around twenty dollars. That
is like a hundred dollars or more now. It was a joy to study,
it was so good. It was a whole bible of medicine in itself,
built around how each drug affected human metabolism.
So I got a little worried. This man's giving us a two-bit
paperback to read because it's a best-seller--as I said, he
also turns out to be one of the authors of this thing- -and to
overlook a classic.
I'll never forget the first day we were going to do animal
experiments with drugs. We were going to do it on rabbits. We
were to put some drops in their eyes, some fairly innocuous
substance. The professor has this big, tall, blond lady
assistant, whom I remembered from Berkeley. They are
Crawford:
Blum:
60
illustrating how you keep the rabbit happy,
animal abuse in this class.
You don ' t want any
While he's yakking, and petting the animal, it is getting
more and more nervous and agitated. Really, it was kind of
pitiful. Here's a class of sixty-five, pretty critical
characters who already sense a debacle. Sure enough, he said,
"Now we've got to put the animal on its back." He tried, and
the rabbit was all over the place. They have to be tied down,
you know, strapped down on a little platform. Finally, he
yells, "Grab the bastard!" And they tie him down. [laughter]
This is after all the garbage about how to be gentle and take
good care of an animal. That's Chauncey at his best.
I worked in this lab with three other students. One
fellow, Aaron Davis, who became a family practitioner out here
in the East Bay for many years, was a lovely man who had a
touch with animals. He got the animal practically mesmerized;
and he didn't turn the animal onto its back, but put the ropes
over the animals ears—didn't tie them at all, just to keep the
animal comfortable. He put the drop into the animal's eyes,
and we can see the pupils dilate, and this and that. It's just
a lovely way of doing an experiment with a happy rabbit. But
the dumb blonde came by, and she took one look and screamed,
"That's not the way to do it. You can't have the ropes over
their ears." All of a sudden our table is a grim spectacle.
Chauncey rushes over to us, and after their fiasco—they
couldn't even get the rabbit turned over—they start picking on
us for bad animal handling. Well, that was the end of my
notions of ever going into pharmacology as long as Chauncey was
around. Just a bunch of dunces; and it's an important field.
It's a huge field.
Why was he in the position that he was?
Well, a great talker. He went on to Texas to be dean of a
medical school there.
Crawford: What was Chauncey 's whole name?
Blum: Leake.
Being a Pain in the Neck in Pathology in Our Second Year
Blum: In our second year we began our pathology. It was my favorite
course because it not only described but explained the
61
abnormalities underlying and subsequently resulting from each
disease. We studied organs and tissues both in the gross and
under the microscope as part of understanding what was going on
normally and then what was going on in the disease process.
Once a week we had a fifteen-minute quiz, each of us
getting a comparable slide from some part of the body to
determine what disease process was going on.
I flunked the first quiz by putting down inflammation and
an organized clot in a vein. The correct answer was
hemorrhoid, which, of course, is exactly what I described. The
rest of the class all had the correct one-word answer and got
an A. A little sleuthing revealed that each fraternity house
had a box of all the slides to be used in the quizzes, along
with the correct answer. Since the exams were the same each
year they knew what to call each slide. Next week was a
repeat. I got a flunk for describing a skin break when
everyone else knew it was a "stab wound." I was mad and went
to the professor, who seemed shocked by what was going on.
From then on we got new fresh slides. I got A's from then on
and most of the class just got by.
Several of my classmates berated me for making life tough
for them—why hadn't I come to them and they would have shared
the slide boxes and the answers?
I was no more but no less of a loner than before. I had
not joined the Jewish fraternity under some pressure. One non-
Jewish frat had indicated a willingness to have me as a member.
However, the frats had little to offer a married student since
their main function was to provide reasonable board and room
arrangements for single men. True, belonging to a frat was the
proper thing to do and the frats were the center of what little
social life there was in medical school.
Blum: Another story from medical school, sophomore year, practicing
physical diagnosis on patients at the Laguna Honda Nursing
Home. We passed a patient out in the hall and she was purple
in the face. She was puffing and breathing hard and looked
like the end was near. Our instructor pulled us aside and
said, "What do you think that is?" I said, "Lobar pneumonia."
He looked a little grim, like, "These students are really
ignorant." He was a nice person, and he didn't berate me for
it, but it was clear he didn't think much of my diagnosis.
This other kid, whom we called the Vermin--it rhymed with his
real name — took a chance and said this was Kussmaul breathing:
62
Crawford:
Blum:
deep, diabetic, acidotic breathing. We were sophomores and
didn't know very much, and the instructor looked pleased, like,
"Hey, we've got a genius in this class."
So I got kind of upset about my poor showing. When the day
was over, I wandered back to the nursing station and pulled
this lady's chart. She had lobar pneumonia. It was so typical
one didn't need experience to diagnose it. The instructor was
a nice person, one you could talk to. Years later when I got
to know him I asked, "Jack, how in the world could you ever
think that was Kussmaul breathing? I verified from the records
that the patient had a typical case of lobar pneumonia." The
response was, "They never put lobar pneumonia cases out in the
hall." [laughs]
That's a great story.
That's how you learn medicine.
Housing During Medical School
Blum: In the third year of medical school at UCSF, we were at the San
Francisco General [then County] Hospital. We got an apartment
at 24th and York. The landlords were born in Italy and had
lived in Argentina and had a son about our age named Tony, who
was a golden gloves champ who ended up getting a masters in
Italian studies here at Cal.
They were lovely people named Calonico and were very good
to us — they had bought us some furniture for this apartment, as
we had none. We then moved across the street from UCSF for my
last year and then we were gone for years and years , but at the
end of the war when I came back to Stanford we went to see the
Calonicos. They still had the four apartments, lived in one of
them and had the downstairs grocery store, which opened at six
in the morning and closed anywhere from eight o'clock on. This
was seven days a week. First a little kid would come in and
get bread, someone else come in for this and that, and this
went on all day long. They knew everybody in the neighborhood.
There were Italians, Germans, Irish, Spanish, a basic mix for
this Mission District area.
It turned out the parents had never taken a vacation
together. Sometimes Papa could go away, sometimes Mama could,
and Tony was in the middle holding onto things too. Well, we
63
weren't settled yet, so we offered to run the grocery store for
them so they could take a long weekend vacation.
They said Tony could show us how. They trusted us, and we
went down at six in the morning to buy produce—the produce
center was on the north side of Market then. We would open up
in the morning and come dinner time we would eat all the stuff
that was getting too ripe—you've never seen such gargantuan
desserts of figs, peaches, melons, bananas and whipping cream!
[laughter]
So the folks got away to Yosemite, and in the course of
this I delivered groceries--! 'd put an orange crate on my
shoulder and take the groceries around the neighborhood. I
started meeting residents who were quite shook up. The
customers whom we knew from when we lived upstairs would say:
"Doctor! What are you doing here? Did you buy the store?"
[laughter] They knew I had been in medical school. Well, I
thought that was kind of fun, the neighbors remembering us,
five years later, and we remembering the neighbors.
Tony lives in our neighborhood in Berkeley now and has
raised five kids; in fact, his folks came here ultimately and
we visited with them after they retired. They wanted to be
with the kids.
And then on Parnassus--! had taken part of my senior year
and become a substitute intern, primarily, as I said, to avoid
unpleasant services. My substitute internship was in surgery,
not that I thought I'd be a surgeon. During this time we lived
in an apartment house across the street from the hospital, and
I remember the first couple of nights I was away--I often was
away all night--and I came home and Marian said, "What's going
on over there—they are killing people." Turned out we lived
across the street from the obstetrics unit and she was hearing
the delivery room shrieks. [laughter] We were in that
building when the Japanese bombed Hawaii and we knew we'd soon
be in the war. One day all our Japanese classmates
disappeared. I don't think we felt any fear, but to have these
people disappear right out of medical school—one of them I was
close to, a woman surgeon who lives in Palo Alto now— Bertha
Akimoto. She was sent off to camp and then like other women
was freed to live elsewhere. She ended up under my aunt's wing
at medical school, Mt. Sinai in New York, and became a surgeon.
It was a horrible thing and the real point is that nobody
objected. I kept thinking that was the way Germans must have
felt about Hitler's increasing viciousness.
Crawford: No sense of outrage.
64
Blum: The concentration camps were in part the handiwork of our good
governor, who became such a great man as a Supreme Court
justice. I told you we went to visit the Jimmy Carter Library
in Atlanta, and the first section there is devoted to the
Japanese incarceration. We were on a tour and there were some
California Japanese people with us and we were just curious to
know how they felt about it, and they said it was just was one
of those things that happened. I was depressed about that
because most of the Japanese I know didn't feel that way about
it. My associate, Yoshiye Togasaki, wasn't very happy about
it—lost everything to boot.
Obstetrics at San Francisco General ##
Blum: My first significant participation in patient care came at the
beginning of my third year in 1941 at the San Francisco General
Hospital. It was in obstetrics and for our debut we were put
in a beautiful new delivery suite, lots of glass for the family
to look in, gorgeous green everything, including the lovely
slick new tile floor. My partner was an old friend from
chemistry days. We students were to take the delivery as far
as we could, and had for guidance probably the best obstetrics
resident anyone had ever seen, Earl Marsh, a majestic,
charismatic person as well as being an acknowledged superlative
obstetrician.
He was one of the few higher-ups that we all trusted, and
we knew that he was genuinely interested and wanted us to learn
how to do things and to succeed. Although women have by
themselves been delivering babies forever in an apparently
straightforward way, this is not how our first case appeared to
us, and we were apprehensive. Our patient was a beautiful
young lady having her first pregnancy. She was also deaf and
essentially dumb. None of her three doctors, if we two
students can be pretentious, could do sign language.
Translators of any kind were unknown in those days. So Bob and
I made a series of one-foot by two-foot signs, the first
saying, "Take a deep breath," the second, "Hold it and bear
down," the third said, "Let it out," and the fourth said,
"Relax." I think there was one other. We couldn't explain any
of this to our patient, who was going into active labor, but
she caught on pronto and we were underway.
For some reason, perhaps out of deviltry, or a feeling that
Bob and I weren't getting sufficient exercise, our mentor, Earl
Marsh, had the lady put one foot on one of Bob's shoulders and
65
one on mine instead of into the usual stirrups on the delivery
table by means of which the deliverers braced themselves. We
cleansed her perineum, and in the process made this beautiful
new green tile floor quite slippery. As we peeled off the
first sign saying "Deep breath" and then the second saying
"Hold it and bear down," this healthy young woman leaned into
the process and Bob and I went scooting across the floor and up
against the back glass wall, no help to our patient. We went
back, put towels on the floor, and went sailing again. Nothing
helped and she kept us skidding helplessly until we connected
her with the stirrups. Then her labor pains got powerful and
Bob and I got the signs all mixed up and all three of her
doctors got hysterical. She was clearly in no danger and
undoubtedly would have done better if three male clowns weren't
laughing uncontrollably.
I can't forget her cute and distressed smile as she
enunciated, "What's so funny?" We sobered up magically and I
swore off obstetrics for life. Bob became an ophthalmologist
and I an internist-preventive medicine specialist. Earl Marsh
continued as the superlative obstetrician, hopefully avoiding
neophyte shoulders and slippery floors. The new baby was a
great success.
Crawford: Well, would you like to venture in to what happened to Vermin
in his career?
Blum: It was desperate. He went into a specialty practice that I
knew in the Bay Area, and they had to get rid of him in a
matter of months.
But his father was a professor at UCSF. So it hadn't been
all accidental; there was some leeway for that. But he was too
much for a practice — or should I say, too little.
Crawford: It was connections.
Blum: Yes. Apparently, they must have told the practice that he was
good. To go to that practice, you had to be good. Such
episodes were also part of the joys of medical school.
I remember I couldn't stand the chief of neurosurgery when
I was in medical school; he was also the president of the board
of regents of the University of California, and the dean of the
medical school, and was a horrible person.
Crawford: Do you want to say who?
66
Blum: Howard Naffziger. He was very famous in his field. I remember
when we were seniors, early in the semester, being in
orthopedics clinic along with a girl classmate. We were seeing
patients, and somebody came up to her and said, "Naffziger
wants to see you." She said to him, "Well, please tell him
that he knows where I am. If he wants to see me, he can see
me." That was pretty wild. Naffziger was a god. By four
o'clock that afternoon, she was locked up for psychiatric
observation, never came back to medical school.
Crawford: Locked up for observation? Because she said that?
Blum: Yes. I don't think she was mentally ill. I think she was so
frustrated, so sick of the old bastard. She never came back to
medicine. She changed her career.
He was that authoritarian. I could tell at that moment how
I was going to relate to him when I came on his service as a
senior. I knew I'd never survive. One could switch out of
fourth year services into an internship if an intern got sick,
and one of the surgical interns did get tuberculosis when I was
a senior. I raised my hand as fast as the poor guy departed to
go into a hospital for six months treatment. So I became a
surgical intern. That was wonderful, and I managed to stay out
of neurosurgery because I was volunteering service by service.
I never did neurosurgery and never had to deal with Naffziger.
I had some other interesting intern experiences at UCSF.
The head of surgery at that time was kind of a farmerish, plain
person, and very pleasant to me, pleasant to his patients. I
worked up a patient for him. He took out the patient's
stomach—most of his stomach—and I did all the scut work. I
tested, did this, and did that, and did an extensive history
and physical exam. Then I watched the surgery. We made rounds
on him several times a day and I kept close contact with him.
When the chief of surgery said, "You can go home. You're fine,
and we won't see you for such and such a time," the patient
said, "I don't want to go home until I see my doctor." He was
talking about me. The surgeon just about busted a gut. Not
with happiness, either. He was a very fine surgeon; but this
was too much for him. [laughs]
I never held it against him. In fact, later on, he did
some surgery on my wife, and turned out to be a pretty crude
guy, as I should have expected.
Crawford: Pretty crude?
67
Blum: Yes. She said she didn't want a spinal, and he said, "Fine,
you don't have to have a spinal." And lo and behold, when it
came time for surgery, she got a spinal, willy nilly. She
objected—that was tough--just shut up and take it, it's over.
I don't go for that sort of doctor approach. So, he wasn't
such a sweet farmer type after all.
Medical school was quite an education up and beyond
technical skills. When we graduated, we put on a play and
invited the faculty to attend. Of course, the play was always
a takeoff on our education, and there was plenty to take off
on: a roast. So I got the task, thanks to my grade point
standing, to invite a couple of the professors that we had
never seen in four years of medical school.
One was the chief of obstetrics. He was kind of a sweet,
old guy. From what we heard he used to drive everybody nuts in
surgery because he always listened to Jack Benny on the radio.
And all during the surgery, he'd be telling all the wonders of
Jack Benny the night before. I caught him just before he went
into surgery, and he was pleasant about it--a good man, an old
man. I said we wanted him, particularly, to come as our guest
--we were roasting him good—to our senior party. So he said,
"What do you want me for? I'm an old man." I said, "I don't
know about everybody in the class, but I've never seen you
before, and I'm graduating; and you're chief of obstetrics, and
we thought it would be nice if we could see you." That was the
kind of medical school it was.
Crawford: You just never got posted to his service?
Blum: Only a handful of students ever saw him. He was making a
fortune. He wasn't there to teach medical students. He taught
residents, to be sure. He said, "Well, that's a thought." He
said, "I'll come." [laughs]
Crawford: You got him?
Blum: Got him. But he never did come. Then I tried to get the chief
of urology, who was really a world-famous surgeon, one of the
truly famous professors at UCSF, a Hopkins man. I came down to
his office early one morning before surgery would ever start-
he spent all day long in surgery—and his secretary said, "He
never sees students." I said, "Yes, but I want to invite him
to the senior party, and so I've got to talk to him." She was
a nice enough lady. I knew her- -a nurse- -she was the head of
his pool of people. She said, "I'll get you in here some
morning between seven and seven-thirty." Well, he threw me out
when I accosted him! He wasn't dealing with students. No way.
68
So he never did get invited, but that was not atypical of
senior faculty at UCSF in those days.
Crawford: That's enough to take you away from medicine, right there,
isn't it?
Blum: Yes. One gets a funny feeling that such professors weren't all
that good about patients either. There were some nice people,
in fact there were wonderful people, such as the pediatrician
Mary Olney in charge of the diabetes service.
Crawford: Was there a mentor in medical school?
Blum: We had some faculty who were decent folks, all of whom—the
decent ones—were friendly. I got involved in a few things. 1
brought the American Medical Students Association to UCSF when
I was a junior. It involved my going to a big meeting in
Boston, and then coming back with the info. Everybody joined
up, all the medical students. The membership was like twenty-
five cents. But it was thought to be a Communist front by the
faculty. We knew that the school was scared to death of
horrible things like that. AMSA, now, is a big deal. Many of
the students here at the JMP [Joint Medical Program] are
officers in AMSA these days.
Well, I was the first one from the West, so I was quite a
hero back there in Boston; but when I brought it back, it was
very clear I was going to have trouble. There was talk about
the Communist menace and all that sort of thing. One of the
first things we did was to ask for lockers for the students,
and a few other minor things. The reason the lockers were in
my mind, I had a classmate who had rheumatoid arthritis, and he
had to carry his microscope up the hill to classes from where
he lived, and he was on crutches. He died about our junior
year, about the time that I brought AMSA to UCSF, and I asked
for lockers. There was no place for him to store a microscope.
Nobody gave a damn about a medical student. It was horrible.
Crawford: That kind of activism must have been uncommon?
Blum: Yes, it was, in those days. The reason I did it and the reason
everybody said, "Go ahead, go ahead," was that I was number-one
scholar of my class.
Crawford: You could get away with it?
69
Blum: Yes, and wasn't going to get wiped out academically. When I
did get back, I immediately lost my scholarship. Within a
matter of hours, one of the nice professors — a really lovely
fellow, became quite a big wheel elsewhere — came up to me and
said, "You've lost your scholarship. I don't know if you know
about it." He said, "Professor Goldman, who is chairman of the
committee, saw to it." Well, Goldman happens to be our Senator
Feinstein's father. He was a great surgeon and probably our
best teacher, but he was a cheap son of a bitch, too.
Crawford: He didn't want any trouble.
Blum: Correct. He wasn't the dean or anything, he was just chief of
surgery at that time. So I started getting all F's in surgery.
It didn't really knock my standing all that much because I'd
built up too much of a lead in grade points. He stopped me in
the hall a couple of days later and said, "Did you get your
scholarship?" The other man tells me that this man has wiped
me out, and he stops me to see if I got it—a neat person.
Well, we didn't expect to get scholarships when we went
through school. My wife and I always said it doesn't make any
difference. We're not knuckling under to anybody. This is the
way it is. But this was another reason to push people like me
towards public health.
Crawford: That must have been a horrific experience.
Blum: The loss of a scholarship was just a wake-up call.
Treating the Poor and Thoughts of a Career in Public Health
Blum: My wife and I both got over any notions about my being a
pharmacologist, and I continued on through medical school.
Ethics had an odd way of popping up in my life. One of the two
lectures we had on ethics, for example, was by a Catholic
gynecologist. When I was an intern later on, he was the head
of the service that I was on, OB-GYN at Franklin Hospital (now
Davies). I worked up one of his patients. I couldn't figure
out why we were doing a hysterectomy. It was a Catholic lady,
in her late thirties. I took a history— nothing. What are we
doing taking out her uterus? That was not a Catholic hospital,
but it was a Catholic patient and a Catholic doctor.
When we got to surgery and she was under the anesthetic,
and we were happily cutting away, I said to the doctor, "I
70
never could figure out why we're doing this when I worked her
up for surgery." "Oh," he says, "Doctor, prophylaxis.
Prophylaxis." And I got a funny feeling about who was teaching
ethics and what ethics were. Was he talking about making
money? Was he talking about her avoiding having any more kids?
It turns out, of course, that is a not uncommon occurrence in
the Catholic world, and also in the Mormon world where women
don't feel able to use contraception.
Crawford: Among Mormons?
Blum: Yes, because they can't stop having kids otherwise, given their
religious teachings.
Crawford: Doctors prescribe it when it's not necessary?
Blum: Well, they just do it whether it's medically necessary or not.
When a woman is getting desperate with her third or fourth kid,
one every nine months, she wants something done, and responsive
doctors will find something. You've got pains, you've got
aches, you've got bleeding, you've got something, but a woman
cannot, on her own, use birth control in many religions. But
if a doctor says, "I think you should have a hysterectomy,"
then the woman can thank the Lord and go on about her business
knowing that she has not violated any religious teachings.
Crawford: And that was this case?
Blum: Yes. It doesn't sound altogether ethical, but I don't think it
was unethical. If that's what she wanted, that's her business.
But he was parading as a good Catholic doctor, too. I
commenced to see that this was one more reason that I would do
better in public health as I waded through medical school.
Crawford: This is what you were seeing?
Blum: Yes. There were all kinds of remarkable things. Nearly half
the students in my class were Jewish. Seventy percent of the
patients were Irish, Italian, or French Catholic.
We were never, ever given one word about the fact that
these people might not believe in the things that we believe
in. We were very casual about hysterectomies. You don't want
any more babies, that's no great sin. Go do it. Yet that's a
real sin for a Catholic.
Crawford: And that bothered you at the time?
71
Blum: You commence to wonder. We don't know anything about these
people. We just treat them like they're one of us, and they're
not. Then you wonder why they often don't do what you tell
them, better known as non-compliance.
Crawford: So you felt that you were coercing them?
Blum: I don't think we even thought that hard. I don't think more
than one or two of us ever thought about it . We never had
discussions of these kinds, but in my mind it was kind of
obvious. I was always aware of race and ethnicity and that
sort of thing, given my background. So it struck me that we
were being less than wonderful doctors.
We were also taught the most stringent statistics. These I
called Mayo statistics. They usually came from a place like
that. You had a patient with gall bladder disease, an acute
inflammation, and if you didn't operate, you would have 5
percent mortality; if you did operate you would have a 1
percent mortality. These were known as Mayo indications,
teaching us how to be a good doctor. The only thing that
nobody ever seemed to mention was that we were getting Mayo
indications for surgery, but we weren't learning how to do
surgery like they do at Mayo. We don't even know how to do
surgery, yet we're going out to do practice with that kind of
irrelevant guidance.
The thing was, if I went out to be a family practitioner,
I'd remember, "We're better off operating." That would be true
if you're a Mayo surgeon, but it ain't true if you're a Cal
general practitioner.
Crawford: But that was the sense of it?
Blum: The sense of it was you had to memorize this garbage about when
to step in and when not. This is not irrelevant. What we
should have been taught was, if you're a G.P., you'll probably
get 20 percent mortality; if you're a good surgeon, 1 percent;
if you leave them alone, 6, so make up your mind what you are
and act appropriately.
Crawford: Now, at that point, if you graduated and went to be a G.P.,
would you also be a surgeon?
Blum: You could be. The bulk of general practitioners were. It's
where the fun was , and the money was , yet you might only have a
year's more training, or you might not even have that.
Crawford: Not up to Mayo standards.
72
Blum: Well, I know where Mayo got their standards. They're
describing the work done by Mayo surgeons. In good hands, yes,
it's much better to have your gall bladder taken out. But we
medical students kept seeing disasters from docs who had done
this or that surgery and sent what was left of the patient back
to UC to patch them up.
This isn't positive learning. So, more and more, I kept
moving towards what I might have done anyway, and that was
public health, saying, "That's where I'm really going to go."
Crawford: Was that evident to you in your first year, already?
Blum: Well, maybe not first year, but in the third year when we
really started seeing patients. It struck me that there were
going to be better uses of my talents, some broader aspect of
things. Much of what we saw was unnecessary illness and could
have been prevented. We'd also see a lot of seriously ill
people who could have been treated better, differently. I
remember we had a visit from someone at Yale, a famed teacher
and practitioner who went on to become a critical figure in
public health, C.E.A. Winslow. I suspect his name is on that
award I got from public health.
Crawford: Is that the Sedgwick Prize?
Blum: Yes. I'm sure he's on that list of awardees. Well, he came to
lecture to us. It was marvelous and we got wildly
enthusiastic. Public health was very tempting, and, again, it
fit in with my notions of how things ought to be done — that we
ought to get there sooner, and it shouldn't be dependent upon
whether people have the money to pay for it.
Crawford: Was the hospital treating people who couldn't afford treatment?
Blum: Yes. Many if not most of the people we practiced on were
charity cases. At nearly all the medical schools, this was the
case. Of course, that's another travesty: teaching on the
poor. You learn all sorts of bad habits because these people
are very different in many ways, very dependent, and had little
if any freedom of choice.
I could give you all kinds of examples. I remember when I
was a junior, one of the famous professors at Cal was treating
a patient. The patient was hard of hearing. Four students
were standing around the bedside, and the patient wanted to
know something and said something to the effect that she
couldn't hear us. She was hard of hearing, and our professor
shouted at her, "Lady, there's nothing worth hearing these
73
days, anyway." And shut her up.
touch at the county hospital.
This was a common patient
I taught medicine at Stanford in the city--their medical
school used to be in San Francisco--and I taught for ten years
there. Then Stanford moved its medical school to Palo Alto in
1960. In San Francisco we used to have mostly ghetto patients
in the clinics. When we went to Stanford in Palo Alto, no.
There were no ghettos. True, a few of our patients followed
us—actually found their way down there; but I couldn't believe
the difference. For instance, in San Francisco, patients often
had everything removed out of them. You had a symptom here and
a symptom there, well, we'll take out your thyroid, we'll take
out your stomach. I mean, all justifiable, but you might have
a patient who was minus everything that was removable by age
thirty. Down on the Farm there was none of that nonsense. I
mean, these people are workers, business people, professional
people, merchants. You don't routinely put anybody to bed with
their ulcers — stomach ulcers — like we did at Stanford in San
Francisco. They had work to do and were helped to do it.
Crawford: And this was the fifties?
Blum: This was from '50 to '60. Of course it's different now. But I
went with Stanford and taught down there on the farm a couple
of years. The commute was a little much for me, though; I
lived in Walnut Creek and worked in Martinez. The first
patient I worked up at Stanford had been a Caterpillar driver.
The Cat overturned, crushed his shoulder but good— so that
there was no way Stanford or anybody else was going to restore
the function of his arm and shoulder. The medical student who
presented the case to me — a senior medical student — came up to
me saying the patient has a date for vocational rehab. We've
figured out he's going to be a tractor salesman. He knows
tractors backwards and forwards. This is a new world. I
looked at this student, neither faculty nor students had ever
heard of voc. rehab, in the city. There they were only dealing
with poor discards who never had a chance; and here we have a
patient and we are already fixing him up to go back to a good
job. This a new world and it's because we're not just dealing
with the desperately poor.
Crawford: Was that a function of too many numbers when you were in the
clinics?
Blum: No. When you always practice on the poor, you kind of give up,
because such people have so little going for them. When you
always work on the poor, so what can you expect, so what can
you do to make the necessary changes to let them lead a
Crawford:
Blum:
healthier life? They've got to go back home. They're not
going to have this, they're not going to have that. I learned
at that point clearly why doctors became so asocial, paid no
attention to patients or their lives or their problems. There
was very little you could do about it. We had social workers
at Stanford in San Francisco. All they ever were concerned
about was how much money you could get out of the patient or
from someone on their behalf. Our patients in the clinics were
poor. They came from the black ghetto right around Fillmore.
What could they pay?
Nothing, or very little, so that was all right, too; but the
point is that you don't spend your time figuring out what they
should be doing for a living, or how they should be doing it,
and yet this was your workday in and out. This was how you
were learning to practice, so that when you practiced on your
own patients you still ignored preventive measures or social
needs.
I remember another patient I had in San Francisco, Mr.
Redmond. A big, tall, handsome, black man, in pretty good
shape; but when I examined him, his liver was down to his
pelvis.
Crawford: Enlarged liver?
Blum: Enlarged liver, and I said, "Do you drink?" He said, "Oh, yes,
I drink at least a fifth every day." He said sometimes more,
and all this very calmly. I said, "Your liver--the next thing,
it's going to shrink up, and you're going to be done for.
You're going to have cirrhosis of the liver. You'll never make
it back, next year, for a check-up. You'll be gone."
Crawford: How old?
Blum: Oh, maybe forty. And I never expected to see him again. One
year later--my charts are laid out—and I looked at this
Redmond's chart, and he's still alive. I can't believe it.
So, I go out there and I say, "Mr. Redmond," and I'm looking
around. Here's this sharp, young-looking guy, and I said,
"You're supposed to be dead." He said, "Yes, I know it. You
told me that last year. Well, I stopped drinking." You see, I
hadn't even bothered to tell him to stop drinking. I did, and
I didn't, if you know what I mean, it was implied, but I
expected no results and I didn't try for any.
Crawford: Many times maybe you hadn't seen any results?
75
Blum: That's right. These are poor people; they do what they do. We
act as though they're hopeless. He told me--I didn't even know
this—he said, "I used to kill cattle in the slaughterhouse in
South San Francisco. My job was hitting the cattle and the
sheep over the head with a pipe." He said, "You can't do that
without keeping yourself pretty well drunk all the time. It's
a horrible job: they cry, they scream, it's awful. So I quit
the job, and I got a job down on the Peninsula on an estate,
and outside, and it's wonderful."
Crawford: You turned his life around.
Blum: Yes, but look how I went about it, if you see what I'm getting
at. No concern at all for the man or his life, saying, "Hey,
you're going to kill yourself. Do something." You kind of
shut off all the social and psychological concerns. Finally,
after a few such cases, you may start pursuing it, pursuing it,
and I did.
I did a lot of it at Stanford. In fact, that convinced me
that I could never practice, that I would always be taking care
of desperately poor people with serious problems, and I could
never make a living. Also I'd go crazy earning that kind of
living, with that clientele who had so little support.
Crawford: You could have left.
Blum: Oh, yes, but such patients gravitated to me. I won a prize
there, once, at Stanford when I was a resident. It turned out
after about six months in the new year the faculty took some
sort of a patient poll as to who was their favorite young
resident, and I won it. I can see why. All my customers had
been discarded by other people. Discarded.
Crawford: So it was your patients who voted you in?
Blum: Sure, because you're spending time on them. But you can't make
a living on them. You try to get resources. You can't do it,
so you fall back on the old ways and don't love yourself for
it.
Crawford: What resources were lacking?
Blum: Well, I mean, somebody to help them get jobs, somebody to help
them to go to school, somebody to help them think through how
to get their lives together. That's what's critical. That's
medicine. When you practice on the poor, you've got problems
bigger than the textbook medical ones.
76
Crawford:
Blum:
Today there are some interesting exceptions. There are
parts of San Francisco General Hospital, which is UCSF, which
are good. They really do quite a job. They speak forty
languages in some of those clinics.
I remember at Stanford, I couldn't get over that, a
patient—a Japanese lady—she could barely get along with a
translator, and they gave her Chinese forms to fill out. I
called the social worker, and I said, "This lady's not Chinese.
She's Japanese." She said, "The alphabet and language look the
same." Here we are talking about taking care of people, but
this is not taking care of people, this is taking care of your
job.
There's a black lady that I'll never forget. She was a
husky thing, and the medical student spent hours working her
up. Every part of her ached, hurt, and almost everything had
been removed that was removable. Her name was Mrs. Jones. She
was probably thirty. She had had two grades in Arkansas or
someplace. She looked pretty messy and disheveled and upset,
and the student presented me the case saying, "This is a
retarded black woman, thirty years old." Well, I got a little
antsy about that. All black women are retarded to persons in
some walks of life. This lady had had everything removed from
her: her thyroid, half her stomach, her appendix, her uterus,
ovaries, gall bladder.
How can you be without a thyroid?
She had part of it left and you replace it with drugs. One or
another symptom had led to all these repairs, and a lot of
residents got a lot of good training in surgery. Not
necessarily at Stanford. She was from elsewhere, but that's
how it was done. I worked her up with the same student
standing alongside me. I went completely over her again,
everything about her. She told me about her thyroidectomy, her
oophorectomy, her hysterectomy, her partial gastrectomy. I
kept watching the student because those are the words that she
used- -he hadn't yet learned them all. This lady was a
brilliant woman: this dishevelled, uneducated, "retarded" black
woman. I didn't make any great progress, but noted that she
had ulcer pains again. With the stomach mostly removed, that
could be curtains.
The student had to go to class, and I took over and got her
squared away—spent a little time with her— then dismissed her
with ulcer prescriptions which she could get filled free, and a
fairly liberal diet. I was sitting up there writing all this
in her chart about 5:30— it just was endless — and I hear this
77
clomp, clomp, clomp up the stairs of the old beat-up building
we worked in. I think I've told you about Bloomfield welcoming
me to Stanford, didn't I? Well, that was the building where
that happened. So, she bursts in on me, and she says, "Doctor!
My husband's leaving me." This is why she was there. This is
a whole other ball game, and we'd never gotten a clue about it
acting as her medical doctor.
The next year I went to Harvard and bumped into some people
whose lectures emphasized, "and you don't know anything about
your patients unless you know why they're here today." Well,
that's why she was there. So we sat down, and it was a very
different discussion; she'd been kissed off and every removable
piece of her had already been removed. So I said, "Well, let's
pick up the phone and talk to the district attorney. Who
knows? It's Friday night, and maybe he's sitting there."
Well, sure enough, we got a San Francisco Assistant D.A. ,
and he started talking to her. I listened in. He was saying,
"Lady, you don't know when you're well off. You don't need
that kind of a husband. Nobody needs a husband like that." So
we sent her on her way, convinced. You should have seen her in
the clinic the next week, after she had pills to cut her pain,
and a new diet. Oh, yes. I also told her she could go to
work. Previous clinics told her that since she had ulcer pains
she should be in bed.
Crawford: Did she have ulcers?
Blum: Undoubtedly, but we did no more x-rays. She had most of her
stomach gone. With the medications and real food and a job, a
week later here comes this nice-looking, powerful woman--a
totally different person, all cleaned up and sharp, two years
of schooling--and she's feeling better. I said, "Go get
yourself a job. What can you do?" She said, "I can do laundry
work," and she'd already gotten a job—strong as a horse, what
was left of her. She was feeling good.
So you see the difference. You've got to look at the
patient. But traditionally you haven't got time to care for
ghetto people. Do the best you can and be gone. Well, that
was just before we moved to Stanford, down on the Farm. When
we left we had a party for all of the patients in our clinic.
We're leaving them in the lurch, but it's the best we can think
of doing. Stanford is moving to the Farm. At the party I see
that Mrs. Jones looks ill and I asked her what was the matter.
She said, "My husband came back."
78
More about Medical School and Student Activism
Blum: I'd taken ROTC in medical school, and the war broke out just
before I graduated. I graduated in July of '42, and the war
formally started with the December attack by Japan in 1941.
I'd already been to ROTC summer camp down at Fort Ord, and that
really clinched my choice of a career because we went on
maneuvers. Fort Lewis invaded us down at Fort Ord and
destroyed our kitchens and everything. These were games, but
it was truly a horrific experience.
We were all medical students. We were reserve officers,
ROTC. I was the tallest one of our group at ROTC, and the
smallest man and I got all the non-fitting uniforms. He got
all the small ones that didn't fit anybody, and I got all the
big ones that didn't fit anybody. They just threw them at us.
So we'd keep trading until we'd get a better fit. Poor little
Mel, he never did get anything more than atrocities; and I got
all these huge things that didn't really fit me, but I had room
for a lot of food. So, when we went on maneuvers, I'd fill my
outfit with cheese and chocolate bars: a regular walking
commissary. [laughs]
Our major- -who was a true idiot, a physician- -walked us
through the fields where the live ammunition was supposed to be
landing.
Crawford: Where was this?
Blum: Fort Ord. Then, when we were captured by the enemy- -by the
Fort Lewis people--! got to see some real doctors who were
really in the army. They didn't even own a stethoscope. I
thought, oh, no. I'm not getting all this training to go be
something like our dumb major, walking people through targets.
When we got back to San Francisco in September or October,
we had a choice of the army, the navy, the air corps, the
public health service, the CIA. Well, there were a whole bunch
of agencies, and you could be going into any of these; but I
went in the public health service because I knew they had all
these marine hospitals, and they were doing medical care for
the coast guard and the merchant marine. Over time, I learned
more about it. They also were the doctors for the commandoes,
and they were the doctors who went on the Burma Trail; all
sorts of goodies. So there were some exciting parts to it.
Crawford: Before we go on with that, let's get you out of medical school.
79
Blum: I simply got absorbed into the public health service. When I
graduated, I went to the San Francisco Marine hospital as an
intern and was an officer in the armed forces, uniforms and
all.
^HBIHPIIIpk mk •••••••
/„•-
BBHHkftiJBBBHI J^^^W* -^*
Entering Medical School at University of California, San Francisco, 1938.
Medical ROTC, July 1, 1940 (Dr. Blum at far left)
Entering the U.S. Public Health Service in 1941
as an intern.
80
IV SERVING IN THE U.S.P.H.S. IN WORLD WAR II--PART OF THE
ARMED SERVICES: 1942-1946
An Internship at the Marine Hospital in San Francisco and a
Brief Stint at a Venereal Disease Hospital in Arkansas
Crawford: What was the term of residency and internship?
Blum: Well, when I went into the service, I went to the Marine
Hospital in San Francisco, and I was out of UC, gone, gone. I
got my internship in the service. I graduated in July and I
was already assigned in June to the San Francisco Marine
Hospital.
Crawford: So you weren't drafted?
Blum: It was the equivalent of drafted. If you were drafted, you
might not go as a doctor, but if you signed up, you could go
for what you were. So, in June, I picked out the U.S. Public
Health Service; and in July reported for duty in uniform. That
was a whole fiasco, too.
Crawford: This is one of those ridiculous situations? [laughter]
Blum: The Public Health Service is kind of sloppy about military
distinctions, but you've got to get a uniform. Well, I went
down to the uniform store.
Crawford: Where was this?
Blum: San Francisco. And they gave me the wrong uniform. So I show
up, and everybody says, "You can't wear this and you can't wear
that." The basics were all right. It was the right color, but
the gold braid was wrong, and so on. I remember one of my
first tasks was to go down and take somebody off a ship, an
injured sailor. Here I am, climbing up the ladder in my
uniform and I don't know whether to salute the front end of the
81
ship, the back end of the ship, the captain who's waiting for
me- -I don't know anything.
Well, you just feel like an idiot. You're walking down the
street, as I did with my wife the day after I got my uniform,
and she said, "What are those men doing? Looks like they're
saluting you." I said, "Oh, my god. They must be." So then I
had to salute them back, you see, and nobody's given you a book
to read, nothing.
Finally, I found a book in the library in the Marine
Hospital where I'm doing my internship and it shows a dress
uniform. Well, I don't know whether we have to ever use a
dress uniform. I look at the front of the book. It was
written in 1914. That's the latest word on Public Health
Service uniforms in the 1940s.
It was just one big, fun game; but I had some good doctors
to work under at the Marine Hospital in San Francisco, and
enough time to really study. I studied like crazy, and learned
a lot. I'd taken my license exams to practice in California
just before I started my internship. So I was licensed to
practice in California.
Blum: A few strange diversions. There were some ridiculous aspects
to the assignment, to be sure. One day I was on ambulance
duty, heard the siren at about nine a.m., pulled my uniform
together and headed out to the emergency portico. We had the
most beautiful ambulance in San Francisco, a grey Packard with
a siren on the roof that looked to have about a five-horsepower
motor. I jumped in, the two techs tooled out, the siren going
full blast while we proceeded at about fifteen miles per hour.
The men were already pretty well looped and fortunately were
the kind that went slowly, not rapidly as a consequence. Our
siren stirred everyone in the neighborhood. We finally ended
up about five blocks away, parked in front of Shnibben's bar,
gathering a crowd. My two men got some beers and sandwiches,
and then we headed down the coast to pick up an officer who had
had a heart attack.
It was a picnic the ambulance men had in mind. I was going
nuts. We did get the man back alive, but no thanks to us.
Towards the end of our year I was on urology. As we were
making rounds one morning, our chief, a fairly young man, was
summoned away, and I never laid eyes on him until four years
later at a party. He told me that he had been flown to his
82
next assignment, sea duty, that same morning. He was assigned
to a ship under construction and spent the year in Long Beach
watching the ship being built. By the time a year had gone by
the ship was launched and he was relieved as he had put in one
year of sea duty.
ft
Blum: I finished my year in the Marine Hospital, and then was
assigned to Arkansas. In Arkansas, I worked in a venereal
disease hospital: four hundred beds, scores of new patients a
day, I mean every day. On the first day I go out to the clinic
and I say, "Mr. Smith." A black man comes shuffling up. These
are very badly educated people. I examine him, doing whatever
has to be done, and then another one, and another one.
Toward noon I get a little message, "Please go see the
commanding officer at noontime." Well, I knew him, so that
didn't bother me too much. I went over to see the commanding
officer, who is a bright young major, not much older than I am.
He said, "For christsakes, you've got to stop calling all those
black people mister and missus. You're just starting a ruckus
here." I said, "Where I came from, they were citizens just
like anybody else." He says, "Don't tell me. I'm from
California, too, and I know all about it; but you're setting
the stage for trouble for these people. They're going to be
beaten up, they're going to be discriminated against by the
whites who are here. You call a black person mister and
missus, you're setting the stage for some awful thing for
them." So I started learning about the South. I listened to
him, and you say "Mary" and "Sam"--a different world. From
there I was shipped to a research center.
Crawford: And how long were you there?
Blum: Oh, just six weeks, but it was a revelation.
Crawford: I see, and you were what rank?
Blum: As an intern, I had one stripe. In Arkansas I got my stripe
and a half, and was a junior grade lieutenant.
Crawford: Lieutenant J.G.?
Blum: Yes, I was really moving. In Hot Springs I met a person who'd
been two classes ahead of me at UCSF, who had also been number
one in his class. He was well on his way to being Surgeon
General, and he did become Assistant Surgeon General.
83
Crawford: What was his name?
Blum: David Price, lovely man. There he was, in charge of the wards
that I'm working on in this Arkansas hospital. And he, too,
was just marking time. We were waiting for them to move him up
to something else. We renewed conversations, and in a way I
had probably followed his tracks. As a student I'd known he'd
gone into the Public Health Service. He was a very bright,
nice person. There was another such person ahead of him, three
of us in a row—three number ones from three classes—that had
done the same thing. The other one became an Assistant Surgeon
General too. I did not.
Crawford: Did your high ranking as a student affect your assignment?
Blum: Ultimately, perhaps; no way of telling. This man had probably
two or three stripes, and I had one and a half; but he was nice
to work for. It wasn't unusual. I'd worked under him when he
was a resident and I was a student. It was old times again.
A VD Research Project at the Penitentiary in Terre Haute,
Indiana
Blum: From there, I was sent to the Venereal Disease Research Lab in
Staten Island, New York, which is a very famous one, and is
where they discovered the use of penicillin for syphilis just
before my arrival. My assignment there was ultimately to go to
Terre Haute for a year as part of a research team, and work in
the penitentiary on human guinea pigs. We had our own
penicillin plant— at that time we couldn't get penicillin, so
we made our own. My first job at Staten Island, my first day—
they don't waste any time— was to go collect the urine of all
the people in the hospital who had been given penicillin the
day before because you can get the penicillin back out of the
urine. We purified it and used it all over again.
Crawford: Is that true?
Blum: Oh, yes. Sure. The body takes it in, and most of it is
excreted in the urine. It was cheaper at that time to do that
than to make a new batch. Then we were shipped to Terre Haute,
and that was an experience. I told you about my research
experiences and my senior officer there in my opening
discussion of this history.
In Terre Haute people didn't know there was a war; a wee
bit isolated, and they resented people in uniform. They
couldn't go hunting because they didn't have bullets and they
really denounced the government, and their children were in the
service! The people next door had stacked over a hundred one-
pound tins of coffee—nice people—but the war didn't involve
them at all. At the same time Terre Haute had a wonderful art
museum. The city was most famous for being the home of Calumet
Baking Powder.
Crawford: You went into that story quite a bit. How do you evaluate it
now? How do you weigh it in terms of the impact that that had
on you?
Blum: The Terre Haute?
Crawford: Yes.
Blum: Oh, it's just surprising that you do those things. You just do
them. In retrospect you start sweating it. I knew we were
doing bad research, but nobody seemed to care, so what could I
do? I was just a junior officer with all these people above
me, right up to an Assistant Surgeon General, and nobody
listened, so that was that. You're not going to be a whistle-
blower in the service during the war, that's for sure. At
least, that's how you feel when you're in the service. When
you're outside, you say, "Well, you're supposed to be a
whistle-blower. What kind of conscience do you have?" It's a
real problem.
One of my physician friends from another outfit was
stationed in Texas. He went to a bar one night and was sitting
next to a Coast Guardsman; and the Coast Guardsman looked at
his insignia and he said, "You're in the Public Health Service.
Well, I'm Coast Guard, and you guys take care of us, you know?"
"Yeah, that's true." They got talking about my case, and this
Coast Guard said, "I know what they do up there in that
penitentiary. "
This was all top-secret research, and this friend of mine
says, "What is it? I've often wondered what he's doing up
there." This sailor said, "Well, they're breeding this real
tough strain of gonorrhea; and they're going to infect
prostitutes, and they're going to parachute them into Germany."
[laughs] This is news. So my friend writes this to me, and
I'm sure he was bright enough to know that it couldn't possibly
be the case, but who knows? So that was our top-secret
research. I learned a lot about penitentiaries, I learned a
85
lot about bad research, and even about prison breaks on my last
day there.
Crawford: You didn't tell me about the break. You told me that you got
quite close to the prisoners, and that they were very candid
with you because you were coming in from outside.
Blum: Oh, I could write a book about it, and a kind of funny book,
too. I mean, of all the crazy things that they did, and of the
wonderful food. They grew it all themselves, prepared it all
themselves.
Crawford: Why should it be wonderful food? That's interesting,
Blum: Because they're doing it. It was run by a marvelous warden. A
man by the name of Swope. In any event, later on he was the
last warden of Alcatraz, but then he was the warden at Terre
Haute. We got to know him well as his guest doctors.
Crawford: And you lived in Terre Haute?
Blum: Yes. Oh, yes.
Crawford: You didn't live at the prison?
Blum: No. We commuted every day and night, just a few miles really.
My job--I had a wonderful job--one, I examined prostitutes to
find gonorrhea bugs to bring fresh bugs in because it was part
of our experiment. So, I was doing practical work. Another
part of the job was to get blood for the laboratory because
bacteria grow on blood agar best. Horse blood is fine, so it
was my job to get the horse blood.
Crawford: How did you do that?
Blum: Well, they taught me while I was on Staten Island. So, I get
to Terre Haute, and I'm the horse bleeder. They take me down
to a boarding stable. They have the most beautiful, gigantic
Percherons, like the beer companies have—big , lovely animals.
When I practiced in New York, we went to riding academies
where they had broken-down race horses; and we had a twenty-
foot long tube, and a needle--a fair-sized needle, about as big
as a pencil—that went up into the jugular, and then you
skedaddled because the horses went wild. I mean the race
horses just went crazy.
86
Crawford;
Blum:
Crawford:
Here I went to work on the Percherons, and I had my long
tube, and I stabbed them, and the Percherons sort of flick
their necks. [laughter]
The race horses were that much more sensitive to pain?
Oh, my. I mean, it was a wild scene. It was risking your
life, and here are the Percherons and they don't even notice
the needle.
You must have been scared to death,
horseman.
You're not exactly a
Blum: No, but you were going to do the job in the service, for the
service, and these horses and the prostitutes were equally
insensible to my presence. I mean, it didn't make a bit of
difference to them.
Crawford: How did the prostitutes identify themselves?
Blum: They didn't. They'd been picked up by the police. Terre Haute
was a town famous for its prostitution because it was the soft
coal mining center. The miners came to Terre Haute for
recreation--R & R, rest and recreation.
Crawford: Were they in pretty bad shape?
Blum: No worse than I've seen elsewhere. I had plenty to do with
them ultimately in San Diego. Similarly in Terre Haute, we
worked with the prisoners.
The jail-break was something else again. The security
system is like that which exists in private homes in much of
Latin America now. There is a big fence around one end of the
penitentiary; and there's a guard house with a guard sitting up
in a loft with guns who watches you. You come in under where
this guard is perched, and he lets you through one door and
talks to you and sees who you are, and looks at your insignia,
but he's above you, out of reach. At least he was in that
penitentiary. Then he lets you through the next gate and into
the yard. There you'd be visible to the front office and its
many guards for maybe fifty yards. Then you come to another
station where they scrutinize you and let you into the
penitentiary building itself.
So, I'm coming back from town and I've got a jar of blood.
It's about my last week at Terre Haute. I get in through the
gates, through the yard, get inside the prison into the foyer.
Here all the guards are throwing out ammunition belts, machine
87
Crawford:
Blum:
guns, and all sorts of armor, putting them out on the floor and
sorting them out, each person taking their share. I'm looking
and thinking, "Well, they're going out to do target practice or
something." I never thought much about it.
There was a man, the associate warden—not the guy that I
said was such a fabulous overall warden, but his chief of staff
who was from my home town, from Napa--a big, burly fellow. We
knew one another. I'd been there almost a year. He looked at
me and he said, "Doc, what in the hell are you doing here?" I
said, "Well, I'm going down to the lab. I've brought some
blood in." He said, "We've got a break! This is no time to be
here. Get out!" He opened the door and sort of booted me out.
I was just on the verge of going into the corridors.
When you review it, you discover that the breaks are
terrible times. Many prisoners don't get to go who were
planning to go, and they're furious. They've lost their cool.
They go quite berserk sometimes. Others become berserk under
the pressure of going. None of the guards inside the prison
were armed, in this prison. I mean never, ever, ever—because
you could have the arms removed from you and then you'd be at
the mercy of these people.
What were the crimes of these men?
Oh, all kinds — from the most desperate to the mild— but it was
a short-term penitentiary, the logic being that even if one was
a desperate criminal, if he's only got six or twelve months to
go, he won't get violent. The majority were there for more
modest crimes— prostitution, drugs, homosexuals from the armed
forces— all sorts of neat people in there. Some of them were
Jehovah's Witnesses, who were conscientious objectors— some of
the nicest people you'd ever meet. It takes more guts to be a
conscientious objector, let me tell you, than to fight in the
armed forces.
During the break about twenty or thirty men got out, cut
the fences and everything, and ended up camping along the
Wabash in the trees at nightfall. Some of them stayed up in
the trees for a couple of days. The guards who lit campfires
and camped under the trees didn't even know that. They finally
were all caught, and they brought them all back. It was really
a revelation as to how other people live, and then to discover
that many of the people were just poor souls who had had a
still in the Ozark mountains, while others were pimps from
Chicago.
88
Crawford:
Blum:
Crawford:
I'll never forget old Frank. He pushed a broom. He was a
pimp from Chicago. It was his third or fourth time in the
penitentiary. I said, "Frank, what the hell are you doing?
You've got to be crazy to live your life this way. Why don't
you do something else?" He said, "I don't know how to do
anything." I say, "Yes, but this crime life is for the birds.
Here, you're pushing a broom in the penitentiary." He said,
"Doc, look, I won't make these mistakes the next time." He was
learning all sorts of things here at the penitentiary.
Then as you get into it further, you discovered that the
judge who sentenced him also owned the house of prostitution
where Frank worked. Just a small reminder of how things are
really run. And that Frank had paid off all the cops. This
was his world, and crime does pay. There were all these nice,
honest people out there, and he was going to do it differently
the next time so he wouldn't be back.
I'll never forget the story I heard when I first got there.
The penitentiary had opened up the year before, and on the
other side of the Wabash was the ghetto for Terre Haute. It
was across the Wabash in a different state, Illinois. It was
notorious for criminals and little gangsters, and living
conditions were awful. The teachers took all the school kids
and paraded them through this penitentiary to teach them that
crime doesn't pay.
Well, this penitentiary had paintings on the walls done by
the inmates. The kids saw a bakery the likes of which they'd
never imag-ried. They smelled food that they never would get to
taste. Then the cells — everything was concreted down, lights
built in, wash basin built in, toilet built in, bed built in
with a steel mattress frame and sponge rubber six inches thick,
all spotless.
That's all looking pretty good.
They converted every single kid, I'm sure, to a life of crime.
They'd never seen anything this nice. [laughter] I mean, the
virtues or the rewards of crime were pretty good. These kids
had never had a bed, never had enough food. I noticed that I
gained weight. I got fat--I just ate lunch there. There were
marvelous meats, pastries and breads. It was a real revelation
as to how some parts of the country lived as compared to
others. The prisoners raised all the food, took care of the
plant, did all the work.
Tell me about the paper that resulted from the research,
because you said that everybody accepted it 100 percent.
89
Blum: Not only accepted it 100 percent, they started off in the first
paragraph that the National Research Council endorsed this
study.
Crawford: What was the name of the study, by the way?
Blum: Well, it was called "Experimental Gonococcal Urethritis in
Human Volunteers." It was published in 1946—January.1
Applying to the Regular Corps tit
Blum: In the early spring of 1944, the USPHS was giving examinations
for the regular corps. For anyone contemplating a career in
the service, there was no choice but to pass the two-day exam.
This was to be given in Chicago so Marian and I took the train
from Terre Haute and stayed with old friends from Berkeley
days. Since there were only four Jews in the entire regular
corps, all well known in academic circles, it seemed unlikely
that I would pass. When I arrived, all the other candidates
came up to introduce themselves and several undertook to inform
me that I would obviously pass since Jews never got through the
physical exam which I had just taken in order to qualify for
the exam.
We had a patient to work up and then a lot of questions to
answer. I have no idea of how well I did, but it was no
scintillating performance.
Came the last half day and we got down to serious
discussions. The presiding Assistant Surgeon General who was
an obvious Southerner whom I didn't always understand wanted to
know what newspapers I was reading. I told him PM, which was a
liberal Marshall Field offspring. He wanted to know how I felt
about their position to do away with the poll tax. I told him
that it was unconstitutional and should be ended. He quite
vociferously assured me that it was constitutional, and I just
as vociferously told him that if it was, it shouldn't be.
I was well aware of what this meant to my career in the
USPHS. But who wanted a career if it was to be oriented to
'Mahoney, J.D., C. J. Yen Slyke, J. C. Cutler and H. L. Blum.
Experimental gonococcal urethritis in human volunteers. American Journal
of Syphilis, Gonorrhea, and Venereal Disease 30:1, 1-39, January 1946.
90
getting along with political Neanderthals? I didn't pass my
exam and was told so before I left that day. Good fortune
takes many forms.
A Faculty Position at Johns Hopkins University Medical School
II
Blum: In Terre Haute, I got a telegram telling me to report to J.E.
Moore, M.D., Chief of Medicine #1 service at Johns Hopkins
University Medical School.
Blum: Hopkins was the place to go for venereal disease training in
the United States — in the world, in fact. The only thing is
that being sent to Hopkins was always kind of an in- joke in the
Public Health Service, your reward for being a good fellow,
which one in a hundred USPHS physicians might get. I figured
that one of my buddies or classmates sent me that telegram, and
that I'm going to show up at Hopkins where they've never heard
of me. [laughs] There were no other official orders for me in
Terre Haute, just this telegram. So I got on the phone and
called the Assistant Surgeon General in D.C. who was in charge
of personnel, and I said to him, "Sir, I have this telegram
telling me to report in so many days to J.E. Moore." "Doctor,"
he said, "goddammit, we don't send these telegrams out for fun.
Now get your ass over there. Show up when we said." "Well,
okay." Now that's been settled. This is clearly not a joke.
So Marian and I took a train to Buffalo and came down the
Hudson to New York City on ship. Then we went on to Baltimore.
It was an awful city, a dreadful city; it's better now in some
areas — and reported to Hopkins, and sure enough, that's where I
was supposed to be; but I had not been sent as a student. I
was part of the faculty at Johns Hopkins. This was a wonderful
break because one can work there forever and never become
faculty.
Crawford: You didn't apply for this?
Blum: No, no. This was just duty. The reason this all happened was
that Hopkins had been stripped of faculty. The services had
taken a whole group and made a hospital unit for Europe, and
another whole hospital unit went out to the South Pacific.
Then they drafted everybody else that could walk. All of a
sudden Hopkins had very few faculty who could get around- -a lot
91
of old timers, really old timers. So they were replacing the
doctors who had been drafted. Don't ask how they got me, but
they did. I was two years out of medical school: one of those
years as an intern, and another year as a kind of a researcher
on that terrible project in Terre Haute.
Crawford: How do you think they did get you?
Blum: I never did inquire, and I certainly couldn't complain. The
only thing we knew was that I was still earning a hundred
eighty- five dollars a month, and the cheapest hotel room that
had running hot and cold water was a hundred eighty-five
dollars a month. So I went down to the USD, and they found us
an apartment out on the Chesapeake where the Martin bomber
workers lived. They had new apartments out there, and we got
one. We had an hour and a half commute each way.
Crawford: Was your wife with you all this time?
Blum: Oh, yes. Always.
Crawford: She went to all these different places?
Blum: Oh, sure, might as well. That was quite a fabulous experience
for us kids from small-town California. I learned all kinds of
things. My first day there at Hopkins, they said, "Now, you're
going to be on the book at one o'clock. You'd better eat your
lunch early. You go down to the main dining room," and they
told me where it was. "Book" meant that I was going to see all
the new patients that come into Medicine One, and anybody who
comes to Medicine One may have any kind of disease, but
somewhere in their history there's a possibility of venereal
disease and so they are going to be seen here first. But it
was straight medicine, internal medicine. We really saw every
conceivable disease.
So I got down to the dining room, a vast place—they "ve
since changed it- -where everybody ate. Apparently nurses and
residents ate there, and doctors, and senior staff. I was
there early, so I couldn't tell too much about who was going to
sit where. I looked around. I thought, "Well, this has got
the makings of trouble because I'll probably sit at somebody's
table, who knows?" Nobody had told me and there was no one to
ask. So I picked out this huge table—it looked like a bunch
of slobs would eat there—because it was right next to the
kitchen with the big swinging doors; not a very comfortable
spot. The least likely place you would sit at if it were up to
you. So I'm sitting there and approaching the end of my meal
around noon when a cute little old man comes in and says, "I'm
92
Dr. Longcope." Well, this is one of the world's famous
internists, and he sits down at the table. I've got this lousy
uniform on with one and a half stripes. Then another old man
comes in and introduces himself, "I'm Doctor Parks." Well,
that's the most famous name in pediatrics at that time in this
country.
Then TeLinde came in, who was Mr. Gynecology. Then Eastman
came in, Mr. Obstetrics. These are the folks who wrote all the
textbooks that I studied from. So, you get that right away.
There was Walter Dandy, the truly famous neurosurgeon. Then
there was Blalock, the cardiac surgeon who did the first big
open-heart transposed artery surgery. These are the gods of
medicine. So I'm sitting at their table. [laughter]
Crawford: Well placed.
Blum: Yes. Very auspicious. And all these people were nice — except
Walter Dandy, who was a little insensitive. Well, then there
was Rich, the pathologist, and I don't know who all else. It
was the place to be for lunch, I tell you. So, after that,
Parks kind of walked me down the hall, and he said, "If you're
not too busy," he said, "why don't you make rounds with me in
the morning? We make rounds at eight o'clock, and you'll see
all the babies and children." He was being real nice, you
know. He knew I'd been traumatized by this; and I had been.
Every once in a while, if I had time and I'd go make rounds
with Parks, a very sweet man.
Crawford: What did you learn from him?
Blum: Well, I learned a little bit of pediatrics. It turned out that
a classmate of mine from UCSF, who had become a pediatrician,
was the chief resident at that moment. Training was speeded up
very drastically during the war and especially at Hopkins,
because there weren't many people left there. In three years
from the day we'd graduated, he was already chief resident. He
had an old infection of the bone, osteomyelitis — a nasty
disease before there were good drugs to treat it, and even now
it is still not a happy thing; and he couldn't walk very much
or very fast.
So, I'd help him make rounds—go see all the kids and
little babies. That was an interesting experience. In the
basement, they had all kinds of kids who lived there, little
deformed children, crippled children, and kids who apparently
weren't going to leave and were being studied. It was like a
hidden zoo, but these were all little kids living there at the
time, and being cared for, and Walt Tasem, until recently a
93
practitioner in Pasadena, would gather them all together and
read them stories every evening. It was beautiful.
Crawford: What a place to be.
Blum: Yes. They were swarming all over him as he read to them. This
was their one real human contact. I'd go visit Pediatrics
whenever I could. I was doing a lot of experiments in the lab
at night, and so oftentimes I was available at night to go
around when he was seeing the babies before they kind of shut
the place down for the night.
We saw a lot of fantastic illness. One night a little kid
came in and we couldn't get him or her going—a little one,
like a year and half. So we called for the resident in
neurosurgery, not Walter Dandy, but the chief resident, who'd
been there for perhaps nine years. Residents went on forever
at Hopkins. His name was O'Tannesack, I believe. He came in a
matter of half an hour. Often the residents stall you off
because they're trying to sleep. This was probably ten o'clock
at night. We tell him about the case, and he just fell asleep
on the desk. We decided, "The child has survived up til now.
Let's let the resident sleep for fifteen minutes, and he'll
feel better." And sure enough, in fifteen minutes, we woke him
up, and he was very bright and ready to roll again. But in any
event, we got as good advice as you could get anywhere in the
world, I'm sure, about what to do with that child.
I just don't remember the details of it anymore, but I do
remember us telling him, "Boy, you're beat, aren't you?" He
said, "Look, I make rounds every six hours day and night on all
the patients in neurosurgery." Every six hours, day and night,
he said, he'd done it for over six years. This is what you
call training. This was about midsummer because there was a
tremendous summer storm, I remember. We had to go and close
all the windows because the water was splashing in on the kids.
He said, "I got married at Christmas. I don't even know where
we live. I've never been there."
Crawford: That's rough, isn't it?
Blum: Yes. That's how they train specialists there, you know.
So it was quite an experience. I learned, and I learned.
It was the best place in the world for me to be. Not only were
there marvelously experienced people, they were all sharp and
fast. I also learned something else. Some of my students
turned out to be some of my superiors in the Public Health
Service, and I told you about the one from Hot Springs,
Crawford:
Blum:
Crawford;
Blum:
Crawford:
Blum:
Arkansas, who went on to be Assistant Surgeon General. Well,
he comes in with his three stripes--he' s one of my students--
and he works up a case and he presents it to me. We had a good
time because we were really old friends; and so I learned more
from him than he ever learned from me.
David Price.
David Price. But that was a kind of reversal of roles. Here I
was faculty and he's just one of the students. They sent them
there for special training; but I got to be there as one of the
trainers.
Isn't that remarkable?
It's really just crazy.
What were your rounds like?
The way the clinic was set up, I didn't make regular rounds in
the hospital. I was in a clinic and I consulted with students.
Everybody who worked up cases had somebody they had to consult
with unless they were faculty like me. When I wasn't
consulting I would have my own cases to work up, and nobody
would consult with me. If you were one of the faculty, you did
your own work. But the students, or anybody who was sent there
for training, had to consult with one of the faculty. The
faculty were marvelously knowledgeable physicians.
Crawford: These famous doctors at Johns Hopkins: did you see more of them?
Blum: Yes, whenever they did anything significant. I was there when
they paraded all the blue babies--the first series of infants
whose abnormally transposed blood vessels were restored
surgically so that the mostly unoxygenated blood which was
going through the body was sent to the lungs as in normal
people and the oxygenated blood then went to the body. These
kids are blue or purple because they're not oxygenated
properly. Another great pediatrician there, Helen Taussig, who
picked out the kids to get surgery, was really deaf and yet she
had to listen to all these children's chests. She listened to
all this and figured out what had to be done. Don't ask me how
she did it. They didn't have all the pictures they do now so
you can see where everything is. We had a parade of about
twenty of these kids, and Blalock had transposed the aorta and
the pulmonary artery. Well, that's something, moving the two
main vessels.
Crawford: I had no idea.
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Blum: Oh, it's tremendous, a world-celebrated kind of thing. They
held an open house in the big auditorium in the medical school.
Everybody who was anybody went to that. That was the deluxe
Hopkins touch. I mean, at UCSF, they happily cut one another's
throats in different faculties. At Hopkins, they really pull
together. So everybody was there, and there were tears shed.
It was a magnificent event to see these kids walk, and no
longer purple, and some were no longer kids, they had survived
longer and were getting about quite well. They had been
restored to life, really; and there was Taussig, bowing this
great big bow. Blalock was kind of a proud guy--he never
really deigned to notice the audience—but there it was.
When I worked in the clinic, people would commonly have
come from all over the world to Hopkins. It was quite the
place, more so than Mayo's actually. I remember once we had
people from Buenos Aires. One of the old-timers said, "How did
you happen to come here to Hopkins?" The patient said, "We
were referred here as the only place to go," and there was some
truth in it, but what they heard was, "You didn't have to come
here. One of our graduates is in Buenos Aires--here is his
address . "
Crawford:
Blum:
Crawford:
Blum:
Crawford;
Blum:
Really?
there?
They would have referred these people to a doctor
Back home, to an alumnus of Hopkins.
So was Johns Hopkins the most famous clinic, then?
It was the place, yes. Harvard was creeping up on it, for
sure; and Mayo always had been good, but Hopkins was better,
really. It was the Mecca. It was called the Mecca.
What other very dramatic things were happening?
Oh, well, for instance, that was the place where, as far as I
know, they made the vaccine for yellow fever, just before I was
there. I don't know if you remember, but tens of thousands of
soldiers who got the yellow fever vaccine also came down with
hepatitis. Hepatitis was not yellow fever. It was good old
fashioned hepatitis, probably B. The reason that happened was
that the virus in the vaccine was weakened with immune serum.
To make immune serum, you had to get volunteers and inject them
with the yellow fever virus. Well, one of the lab people that
I worked with as I was doing the lab experiments was a nice
spunky gal, who volunteered to be the guinea pig to make the
anti-yellow fever serum which would then be put in with the
yellow fever vaccine, and neutralize it, so it would remain a
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Blum:
living vaccine, but one that wasn't going to cause yellow
fever. She got hepatitis while they were doing this. She
worked in the lab all the time, which is a good place to get
hepatitis. So, even though her blood was diluted out a
millionfold, one smidgen of her blood was in each dose of
vaccine. Just that much is what caused the hepatitis. It
caused something like eighty thousand cases.
Crawford: Caused it?
Blum: Yes, the vaccine was good, but it also carried hepatitis, which
nobody understood or could test for at that time.
Crawford: They didn't know that she had hepatitis?
Blum: Well, they didn't know that that made any difference. That
mishap was when they started catching on. Those were still the
dark ages for much of immunology.
Crawford: So you just surmised that, but nobody charged Johns Hopkins
with it?
Oh, no. Who would have known differently? It so happens that
when I was an intern in San Francisco I had taken care of
eighty of these hepatitis cases who were in the Coast Guard
when they were vaccinated for yellow fever.
Crawford: These people had been vaccinated?
Blum: They had been vaccinated, and they were troops from the
Aleutians, and going overseas to various destinations in the
Pacific where they might meet yellow fever.
Crawford: Was that a bad strain of hepatitis?
Blum: It was mean, but there weren't too many deaths. Out of the
eighty, only one looked like he was going to die from the acute
disease. If it really was hepatitis B, a sizeable fraction or
more would die from it, sooner or later. If it was hepatitis
C, many more would die. In those days we couldn't even tell
which was which, didn't even know of the many varieties of
hepatitis. If it was hepatitis A, none of them would die. One
kid that I took care of specially—because he was the only one
that looked like he was dying- -was in and out of a coma for
months. Lo and behold, the last I heard of him—we fought to
get him out of the service but couldn't— he was doing four
hours on and four hours off marching guard duty at the Coast
Guard in San Francisco. If you want to bring about a relapse,
97
this would be a great way of doing it. We couldn't convince
anybody. They said, "He's all right." So, that's that.
Blum: Although medicine at Hopkins was probably as sophisticated as
anyplace on earth, how one lived in Baltimore was not. One of
my early patients had a grim flesh-eating disease girdling his
genitalia and starting around one thigh. Called granuloma
inguinale, it was probably more a product of lack of hygiene
than a venereal disease. Fortunately, it responded to lots of
warm water sitz baths. The lesion was a horribly malodorous
one and victims soon made themselves known when they entered a
waiting room.
I had a nice enough male with the condition, carefully
explained the soaks, the temperature, and sent the man on his
way to return in a few days . When he came back I knew he was
there from the odor wafting into my office. I called him in
and asked him about the sitz baths. He responded, "Doc, I've
got to level with you. I live around the corner from here in a
unit with eight other people. There is no running water, the
toilet is a communal affair out in the centrally located back
yard shared by about a dozen buildings that enclose it. To
soak myself four times a day in a tub of warm water means I
have to get a tub, take over the living room, where all nine of
us sleep on the floor. To get warm water, I have to heat it on
the kerosene heater after I haul the water up from the back
yard, and it's hot as hell in the room now without using the
heater." This man was turned over to the most effective social
service unit I ever saw in a hospital and they got him
relocated so he could have warm soaks. It became pretty clear
that medical advice by itself isn't enough.
Many years later I was the opening speaker at the National
Social Workers Convention being held in San Francisco. I was
making my usual thrust about what was most important to health
and recounted an episode from Hopkins that pointed up the
relationship of medical care to other social needs. I had come
in to Hopkins fairly early on a truly cold wintry day and found
the grand tunnel which connected all the medical buildings
totally jammed. I spotted someone in a white coat and asked
him what had happened, imagining a disaster of some sort had
driven all these people to the hospital. I got a laconic, "Oh,
it's really cold." I immediately understood the reality that
the ghetto neighbors couldn't afford the twenty- five cents for
a gallon of kerosene to heat their house, and I proceeded to
work my way along the hall to our building.
98
On reconsidering what was taking place, it was obvious that
for lack of some small amount of money for fuel, thousands of
persons came to Hopkins to get warm. But there was a price,
people had to say what was bothering them and be assigned to
the appropriate clinic. A clinic workup at Hopkins was no
casual affair, taking student, staff, and faculty time and
facilities. Basic lab work was always done. So, on such a
morning hundreds of thousands of medical dollars were spent to
offset the need for a few hundred dollars of kerosene.
But that isn't all. Patients don't tell you they are cold,
they think of something. When nothing of consequence
eventuates, the patient may get more tests, and if one of them
shows any deviation, they will get a referral for a more
elegant and costly clinic for a workup. If the cold spell
lingers on, and the patient is persistent but seems physically
well with no abnormal tests, he or she might well end up in
psychiatry. I untangled just such a case that had been sent to
a mental hospital ultimately and it took our social workers
days to get her out. Thus are social needs converted to
medical care.
I had a few more such tales, made my point about the need
to look at people in a more comprehending, comprehensive way,
and asked for questions. A grey-haired tiny lady rushed to the
nearest microphone placed in the aisle for questions and
started in: "I'm a social worker from Hopkins." I was sure my
goose was cooked and that she was going to undo my good work in
one way or another. "And," she went on, "I want you to know
that now we have exactly the same problem in the middle of
summer because in the hot days everyone is afraid of the
riots."
There were other regional differences to be observed about
how health care and health intersected. On my second day in
Baltimore, I took charge of a medical ward at Baltimore City
Hospital as part of my assignment to Hopkins. Going to the
dining room for lunch put me at a table which included two
newly returned interns who had shared a month's duty relieving
a rural practitioner on the Eastern Shore. He was taking his
first vacation in decades and asked the interns to share the
work and keep all the income they generated. They were full of
the rural practice they encountered as compared to what they
were learning in Baltimore.
Their most memorable encounter apparently was with a
youngster from a rural ghetto who had crashed through a window
and was badly sliced up. They spent hours meticulously
stitching him together so that he would have minimal
99
disfigurement. When they got done and were admiring their
handiwork, the doctor's nurse, who was the mayordomo in charge,
explained that the doctor had an immutable rule of charging two
dollars a stitch and that the bill for this poor family would
run into several hundred dollars, which they could never pay
and thus would leave the doctor and the family in a bad
relationship. The interns debated for a while and then very
carefully removed every other stitch.
They had been somewhat afraid of the rural obstetrics
aspect of this busy practice, but were relieved to learn that
the doctor always charged fifty dollars per delivery, but if
the people chose his nurse to do the delivery, it only cost
them thirty-five dollars. Essentially no one ever used the
doctor as a result, and the interns were home free as they had
no deliveries. Lunch was over and my tour of rural general
practice in Maryland in the mid-forties was also over.
I*
Blum: One more story about that time: When we lived out on the
Chesapeake, almost everybody in our building was classified by
us as hillbillies, most from the South, many with college
degrees. There was one family we were close to. He was a high
school principal with a lovely wife, Edna Mae, who went around
in her bra when it was hot--just as modest and sweet as you
could ever want to see. There were eight apartments, each with
a refrigerator and no stove, but we had a couple of burners.
As I mentioned, I was earning $185 a month as a first
lieutenant, and that was the rent at the Hotel Baltimore
downtown, so the USO found us this apartment, a part of the
housing for the work force at the Glen L. Martin bomber plant.
A month or so after we were there, we were sitting at
breakfast and saw this tick crawling up the wall, so I put it
in a bottle and took it to Johns Hopkins for inspection.
Everybody there got hysterics: "That's not a tick, that's a
bedbug!" [laughter] Marian was a social worker and her
district was around Hopkins, which was a bedbug's paradise with
all that poverty, and Marian thought she'd brought them home.
I thought I might have gotten them at Hopkins, for they were
not unknown on the wards.
One night soon, though, the place was crawling with them
and it was hot, and we went outside to sit on a bench to decide
on suicide, escape, or what. There were some schoolteachers
from next door sitting outside. We found out they had the same
problem. We soon asked all the other tenants about it, and
found out that one of the previous tenants who had no spouse
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Crawford:
Blum:
and had to fend for her kids on her own had left the building,
and the bedbugs she abandoned in her apartment had gotten
hungry and gone searching for food. [laughter]
So I went down in my uniform and told the rental service
that they had to do something about this. But where we were
wasn't in the city of Baltimore, and no one could be forced to
do anything. So I decided to refuse to pay our rent, using my
status as an officer, and that made a difference to all our
neighbors who joined in the boycott. Within a day or two the
management came in with oil sprayers and destroyed everything
we had, and that worked for about an hour. Then in another
week, since we still refused to pay our rent, we got notice to
leave so they could fumigate the entire building with cyanide.
We left practically in our bathing suits so we wouldn't take
bugs out, we stayed with friends, and when we got back it was
like a morgue — there were dead animals and bugs all over--yet
it was a new building, about six months old! Welcome to the
subtropics.
In the course of cleaning out our building they had
discovered about a hundred aborted fetuses in jars. Nobody
accused me, but it didn't look good. An army doctor who lived
in the same housing told me he had left his name with the
management in case of emergencies and he said he had been
called for a childbirth. It had been messy, the mother was
taken to the hospital, and when it was over no one could find
the born-alive baby. Well, one of the well-meaning neighbors
in attendance had put the baby in the refrigerator to get it
out of the way, as the mother was bleeding. For the heartland
of civilization, famed for the School of Public Health and for
its Department of Public Health, it was easy to see that public
health must be in desperate shape elsewhere, or that a good
publishing record needn't be based on accomplishments.
You left Johns Hopkins when?
The war was nearly over, so that would be what? Forty- five?
Actually, I was shipped out of there to Hot Springs, Arkansas,
for a few months. The war was over in '45, and then I was sent
to San Diego to be part of the County Health Department. They
couldn't get people for public health jobs that early in the
demobilization.
The U.S. Public Health Service assigned people to all kinds
of places. I was assigned to the San Diego Health Department
to complete my tour of duty before I would be decommissioned
and be allowed to take my fellowship at Stanford. San Diego
101
had a fine health department. It was a wonderful place to
work, a very enlightened kind of county/city government.
Assignment to San Diego
Blum: There were all these prostitutes — that was a huge business with
the air force, the army, the navy and marines based in San
Diego. San Diego was hopping all the time. Most of these
people were separated from their usual family and friends, and
therefore from any restraints. If they had a wife, that would
be the exception, and that was not an issue. So the exposures
were fierce, and the rates of venereal disease were
spectacular.
Every day and night the police were raiding, raiding,
raiding, and then every night the prostitutes were brought into
the city jail, and somebody had to examine them for venereal
disease. In the first place, just looking isn't that
convincing, but if you think you suspect gonorrhea, you can do
slides. As far as syphilis is concerned, you've got to do
blood tests. It takes a day or two to get a result. So
somebody had to go down there and examine all these women, and
do the various tests. You line up these poor ladies, and prop
them up on a GYN table, and do the exams, take specimens as
indicated. And there are several other venereal diseases that
had to be kept in mind. We didn't know about chlamydia in
those days.
That was a pretty hectic scene, but I soon discovered by
looking at the blotter in the jail that 90 percent of the
prostitutes who had been arrested weren't there. If there were
a hundred of them arrested last night, you might see ten or
fifteen. So it was kind of an idle gesture. I asked, "What's
happening here?" "Oh, the bail bonds people have released them
all." They've come in with the bail--a few hundred dollars
bail—and the prostitutes forfeit the bail and go back where
they were working. That's a good old-fashioned way of handling
problems in the courts and in the jails.
So I said to the chief of police, "You'll have to do
something about these people coming in here with venereal
disease; you're not keeping them." "Well, we don't put a hold
on them until you see them." I said, "But then they're not
here to be seen. What are we going to do about it?" They
said, "Nobody's ever been able to do anything about it." I
said, "I can think of a way. You don't mind if I put a cot
102
here on the jail patio under a banana tree? I'll spend the
night here and examine each of these women as they're brought
in." That gave them something to think about. So they said,
"You don't have to do that, Doctor, that would be too much to
ask of you. They'll be here in the morning." And they were.
I had to examine armies of prostitutes. Sometimes you'd
see them, and they were black and the next time they were
white. You'd say, "How can this be? They can't be turning
different colors?" Well, they wanted different clientele for
the night, given the ship, so they put on a routine of being
black for that occasion.
Crawford: The same women?
Blum: The same women. Oh yes. I mean, they were appealing to
different customers. Really quite beyond belief, what you'd
recover from the vaginas of these woman. All kinds of gadgetry
that the males were using and lost. It was quite an education.
I didn't know there were such things. This work wasn't exactly
exotic, and surely not erotic, but it was interesting.
Crawford: Did you ever write anything about that?
Blum: Oh, lord, no.
Crawford: Were they treated?
Blum: Of course, and fast.
Crawford: In the jails?
Blum: Yes, wherever. It was a rough, a rough scene. And then I
remember, the armed forces wanted us to go down and treat all
the prostitutes in Tijuana because the troops were at liberty
for one, two, three, four days, or just even for a night. So,
somehow or other, we got roped into checking prostitutes in
Tijuana.
Crawford: The Mexican authorities wanted that?
Blum: No, they didn't, but our military did, and business is
business. These armed forces people leave hundreds of
thousands of dollars, and maybe millions, in the course of a
week. So no one in Tijuana was going to interfere with that.
We finally came up with a brilliant idea. I don't know how
good it was, but they lined the prostitutes up, they knew who
they were, and we gave each of them a million units of
penicillin. And that was that. In those days before
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Crawford:
Blum:
Crawford:
Blum:
Crawford;
Blum:
Blum:
resistance to penicillin it would get rid of their gonorrhea
and would get rid of syphilis as well.
Quickly.
Quickly. And so we didn't examine them at all.
routine: we'd go down once a week.
We had a
1 remember when I was at Hopkins, we already were getting
stories from Europe about the Germans. They had beautiful
houses of prostitution in France, and checked every prostitute
every day, and did this and did that.
The French did?
No, the Germans. Oh, the French, that's another story--they
did nothing. But the Germans — this was rest and recreation for
the troops. Yet they had a rate of venereal disease that was
spectacular. You can't control it just by inspections of
prostitutes. The same prostitute will service maybe fifty,
eighty, a hundred men a day. So, if one leaves a disease, the
next one picks it up. The prostitute doesn't have to be an
incubator. She can just carry it from one to the next. Well,
they finally dismantled all their inspections of prostitutes.
The United States got all the records as they were captured
early. They established a new rule: if a soldier got venereal
disease, he was shipped to the Eastern front. The Western
front wasn't hard ball.
Did that help?
I don't know. The war was almost over. But in Tijuana we
wasted no time on inspections. We treated according to
occupation, e.g., prostitute.
**
Then we had an experience with smallpox. Smallpox kept coming
back with the troops off and on. Here I was, the junior
person. So, I got to do whatever was interesting or looked
like it was a little crazy, a little dangerous. We get a call.
There's a small aircraft carrier coming into the harbor--San
Diego is a big naval headquarters. It's been at sea for three
years. It's coming in flying the yellow jack--a little
international flag that says, "We have a plague aboard." It
could be smallpox, it could be yellow fever, it could be
bubonic plague. This carrier was not allowed to dock in the
Philippines. It wasn't allowed because of the case of
104
smallpox-- just one on board. It wasn't allowed to dock in
Hawaii, and they came to San Diego, their home base.
It's not up to the navy to let these people ashore. It's
up to the local health department to make the decision whether
the crew can come off or not. In Hawaii and the Philippines
they wouldn't let them off. "You stay right on and go
somewhere else." These were men who've been at sea for three
years. So the commanding officer starts telling us what to do,
as they usually do, but we didn't pay much attention. It's
like, "This is our decision. We want to ask you a lot of
questions, but don't tell us what to do." My wife is sitting
out there in the car, waiting for me, because that night we
have to go to a meeting way up in the mountains to explain to
people something about polio. It was one of those places you
drove for two hours to get to.
Crawford: You had no idea what you were going to find?
Blum: Sort of. So, I went on board, and here is the most classic
picture I've ever seen of a case of smallpox. The fingernails
are coming off, his skin is coming off. He's going to survive,
but all this shedding skin is contagious, and where is he
berthed? Well, the only cool place in the ship, the sick bay,
is in the center of the ship, and here's an air pipe two feet
in diameter blowing across this patient. He's under the blast,
but it's moving the scabs all over the ship.
[Interview 3: February 3, 1997] //#
Blum: The patient is lying under the major air vent at the center of
the ship in the sick bay. He was put there to keep him halfway
comfortable because that area was cooler for patients when they
were in the tropics for years at a time. So all of his crud
and scabs were carried all over that ship.
I went to talk to the two medical officers, who were
younger than I was. They said, well, he didn't really have
smallpox. It was probably syphilis, and syphilis does give
people all kinds of skin diseases. His disease converted his
blood test to a positive for syphilis--a weak positive—but
smallpox does that. Even smallpox vaccination will sometimes
give you a weak test for syphilis. So they were praying to god
for syphilis, and they said it couldn't be smallpox.
They were navy doctors. They had just gotten out of school
a year previously and there they were. But they had not taken
any chances; they had gotten shipped to them some water buffalo
vaccine—the strongest smallpox vaccine. Apparently the
105
smallpox virus grows beautifully on the water buffalo; and they
had used that vaccine to immunize everybody on the ship three
times against smallpox, just in case it wasn't syphilis. So
you can tell that their confidence was a little low when it
came to saying it was not smallpox. I said, "It i,s_ smallpox as
far as I'm concerned, and that's the end of that." So we
negotiated about how to get the men off the ship. I mean, you
can't keep them forever after three years. There were
thousands of women and children waiting for their husbands
right there on that dock. The patient went to the San Diego
naval hospital.
So we said, "Okay, a third of them off. We'll clean them
up, and they're off." And they get two weeks leave. So we
figured out how to best clean them off. Well, that isn't what
the naval officers understood that we negotiated. They thought
we had negotiated eight hours leave, one-third of the ship off
and two-thirds on. Then that third would come back and the
others would go. I discovered that a day or two later. We
threw up our hands in horror because men were coming back to
the ship day and night, and the clean-up is kind of a scary
j oke anyway .
Crawford: What is the clean-up?
Blum: Well, making sure that they're not walking out with any scab
material on them, contaminated clothes, gear.
Crawford: But they could be carriers?
Blum: Yes. They themselves are not sick, and as they were immunized
they will never get sick; but they could be carrying the scabs
from the disease and that carries the virus.
So we decided to start sending them home after a few days.
A third were gone, then in so many weeks another third could be
gone. In the meantime, they were already off the ship. So we
immunized all San Diego: every man, woman, and child.
Crawford: How many?
Blum: Hundreds of thousands. Five, six hundred thousand. Probably,
that was about all the people there were then. I don't
remember the details.
Crawford: Was there a public health scare?
Blum: We decided to immunize. It turned out that there were cases in
Seattle coming off ships where just the blankets were infected.
Crawford :
Blum:
106
So we had ample ground for, "Here's a ship with smallpox." All
on my say-so. It was kind of scary to use such authority, and
then make a mess of it.
The alternative, the only real alternative was just to
quarantine the men?
But they had been at sea for three years and they didn't need a
quarantine, it's the ship that's the problem. They were on
that ship and supposing the wind blew a few more scabs around
anyhow .
So we made it. Some of these people went across the
country to their families. Well, that was the end of it, but
at the time of the ship inspection I said to myself, "I think
I'll get an immunization right here on board ship. You guys
can immunize me." One only gets immunized every so many years,
and I hadn't had any for a couple of years. So they immunized
me with that nice water buffalo vaccine, [laughter] and I
vaccinated my wife with more of that vaccine right in our car
before we dashed off to our night meeting.
Where did they find that?
Oh, they picked the vaccine up from the Philippines. Somebody
delivered it to them.
How did you call the population in?
There were announcements in the paper that there was a
potential for smallpox. Ships were coming back. People
already heard about cases in Seattle, and here was a ship with
a case on it.
Crawford: Quite a story.
Blum: Well, the life of a health officer needn't be dull. [laughs]
Crawford: Did you have anything else as critical in San Diego during your
time?
Crawford:
Blum:
Crawford:
Blum:
Blum:
Not particularly.
107
Going AWOL; Back Surgery at the San Francisco Marine Hospital
Blum: My departure from San Diego had a special personal aspect. My
time in the service was drawing to a close and we were looking
forward to Stanford. At that point I had a recurrence of a
herniated intervertebral disc (my first had been in my second
year of medical school and had slowly cooled down over the
years, leaving me in good physical condition).
Nothing seemed to help the back and leg pain. Since I was
entitled to care at the tremendous Naval Hospital in San Diego
(at the edge of lush Balboa Park and with broad ocean views as
well), I turned in and found myself in a quiet junior officers
wing. I didn't know it then, it only came out later that the
head of the hospital was bucking for a commodore's rating,
achievable most directly by increasing the numbers of patients
at the hospital. The easiest way to do that was with a policy
of easy admittance and difficult discharge.
After four days of pleasant care without much medical
attention, I got a basic exam. Because this was not a new
condition, one that in fact predated my entrance into the
service by several years, I was told that I could get no
surgery for a preexisting condition, but that I should remain
in the hospital. Since my condition wasn't changing a great
deal and I was soon to begin at Stanford, I asked for a
discharge. Lo and behold, I was not fit for duty and therefore
could not achieve a discharge from the hospital until I was.
No treatment could be given, nor could I go on about my
affairs. A lifetime, or even just a few months doing nothing
in a hospital (no rehab or exercises were offered either) would
be like a prison sentence.
We called some friends in L.A. who had a car, my wife
shipped our belongings to San Francisco for storage, and on one
of her afternoon visits we clumped up the bedclothes on the bed
so it looked like I was asleep and got me dressed up for a
stroll.
Marian carried a few parcels, essentially my bedclothes, we
met our friends at their car, and went on to L.A. where we had
pullman reservations for San Francisco. We went to a friend's
house in San Rafael. I'm still AWOL, no doubt, from the San
Diego Naval Hospital.
At that point I decided to begin my residency at Stanford.
Took the bus from San Rafael and completely collapsed with back
pain when I got to San Francisco. We had gotten an apartment
108
by then, and our belongings were in it. I lay on the floor
until Marian came along, got an ambulance and had me delivered
to the Marine Hospital. Although I was discharged from the
service, I had several months leave coming, and the USPHS had
no problem about accepting and treating me. We forgot about
the San Diego Naval Hospital.
Crawford: So you came to Stanford.
Blum: Yes, but let me backtrack to say how I got there. When the war
suddenly looked like it was going to be over. I was in San
Francisco on V-E Day, I went over to UCSF to see about further
training. The chief of medicine was a windbag and when I got
to his office I could hear him gossiping. His secretary said I
could see him in a week, that it was tough that my furlough
would be up before then. So I went over to Stanford. Had
never been there before.
Blum: I came to the reception area for the medical school and asked
to see Dr. Bloomfield, one of the celebrated internists in the
U.S., and certainly the dean of them all on the West Coast.
The receptionist got him on the phone and he told her to send
me up to his office. I got up to the fifth floor of the
horrible old building in which the medical school was housed,
but couldn't find his office, only a door marked fire escape.
So I went back down to the receptionist and asked her to call
him and tell him I was starting again because I had gotten
lost.
She said, "He says to stay here, he'll come to get you."
He did, and his office was behind the door marked fire escape.
He found out what I wanted, more training in internal
medicine. He asked me to get a letter from my chief at Hopkins
who had been a fellow resident with Bloomfield at Hopkins.
J. E. Moore sent off a letter when I got back to Baltimore,
Bloomfield accepted me that same week and awarded me a
Rockefeller research grant as well.
I had become a Stanford person for life when Bloomfield
came downstairs to fetch me, a person totally unknown to him or
to anyone else for that matter. And I've been a Stanford
person ever since, as we shall see.
II
Crawford: So he was waiting for you?
109
Blum: Yes. I got the recommendation Bloomfield asked me for, and
eventually it all came about, the residency and the
Rockefeller, and I found myself at Stanford.
Crawford: Did you have surgery for the disc problem?
Blum: Yes. I was still in the service and had surgery in the San
Francisco Marine Hospital and got an infection. If it hadn't
been for penicillin, I probably would have died. I got an
infection between two vertebrae. I had a fever of a hundred
and five, a hundred and six, day after day. My doctors really
paid no attention to me at all; but, of all things, the head of
the Marine Hospital in San Francisco was a tough old curmudgeon
named Hollingsworth, and he had shaped up the Marine Hospital
in Stapleton--the one where I had first started my career in
the VD research lab.
He took over. He had shaped that hospital up from a
disaster area; then he took over the one in San Francisco about
the time I got here, and it too had become a disaster area
since 1 left as an intern. He had rounds every morning at
eight o'clock; and every morning at eight o'clock, if a doctor
wasn't there, let me tell you, he'd soon hear about it.
Doctors and everybody had to show up unless they were in
surgery. He always knew more about the cases than they did.
He knew more about medicine than they did.
This was a grand old man. He discovered me with this
wonderful fever, just lying there. No one was doing a
goddamned thing. So he moved me, and I started getting
treatment. Once the old man starts looking after you, you're
going to be looked after, you know.
Crawford: So he took you under his wing?
Blum: Yes, and the Stanford people who knew I had been unable to come
to work at Stanford started coming in at that time. They may
have been aware of the fact that I had been operated on by
nobody less than Stanford's chief of neurosurgery .
Crawford: Who was that?
Blum: Lusignian. He was a well-known neurosurgeon. He worked in the
Marine Hospital as a consultant, and he did their tricky
neurosurgery.
110
V RESIDENCY AT STANFORD AND ON TO HARVARD: 1946-1948
Treating and Studying Syphilis
Blum: At Stanford I was getting the training a resident would get
even though I got a good bit more money as a research fellow.
That was a friendly environment. I've never seen anything
quite that friendly. Hopkins was friendly, but Stanford was
more so. I'd known that as a student at UCSF. We were
students side by side at County Hospital in San Francisco in
our third year. The Stanford people were happy, cheery folks,
and we were always a bunch of disgruntled bums. They laughed
at us. They used to kid us about the sad sacks we were.
Crawford: What was the difference?
Blum: How students were treated.
Crawford: Was it a matter of numbers?
Blum: No, same size class, but there was a different attitude. I
remember when I first came to Stanford and I had a fair bit of
free time. I got into all kinds of things. I went to x-ray
almost every day, fluoroscopy, to learn how to handle a
fluoroscope. They had, probably, the number one x-ray man in
the world there at the time, and he was teaching the students
in small groups.
I remember one x-ray session. There was Newell--a famous,
kindly man—asking the students questions about "why are we
doing this?" and "why are we doing the fluoroscopy this way?"
One of the students was just abysmal. He just didn't know
anything. It was kind of funny--or sad. Newell finally got a
little exasperated, but he wouldn't be mean. He finally asked
the student to classify the foodstuf fs--they were looking at
the gastrointestinal tract. The student came up with animal,
vegetable, and mineral. It sounded like kindergarten. Poor
Ill
Newell didn't have any hair, but he was reaching for it. The
rest of the students were shying away from this poor victim, a
kid who drove a big, beautiful car. He was, I think, bright
enough; just not interested in learning anything.
Finally, Newell said, "So-and-so, you're going to be a
doctor next year. How can you pass yourself off as a doctor
and be this ignorant? You can't do it. You've taken on some
agreements with society when you're a doctor. You can't go out
there and be an ignorant bum." That was a bawling-out at
Stanford. At Cal, we were used to, "Okay, one more trick like
that, and you're out." That was a different world. True, this
student probably should have been out. But the appeal was made
to his better side, and in no way was it made as a threat to
his survival.
Crawford: Did he straighten up?
Blum: I don't know because it was too close to the end of his
training, and he wasn't one of my students.
Crawford: What was your duty?
Blum: As a resident, I was supervising students, taking care of
patients primarily, and doing research because I was a research
fellow so I had taken on a research project. We had just a
wonderful population to do research on. It was a project,
again, which might raise some ethical hairs. We were looking
at what happened to patients with syphilis — clearly proven
syphilis — some who had been treated satisfactorily, and some
who had not. There were many who had not taken treatment for
one reason or another.
Crawford: Why?
Blum: Sometimes they had decided not. At other times, they had had
the disease for years and years, and had never known it. The
treatment wasn't without its dangers and miseries, and we and
the patients had come to an agreement not to treat. So we had
the chance to follow and study these people at some length over
many years. The people who had not had adequate therapy did
have more than their share of ultimate vascular system disease,
nervous system disease, and so on. There's just no question
about it. That study was one of my major publications.1
'Blum, H.L., and C. Barnett. "Prognosis in Late Latent Syphilis."
Archives of International Medicine 82:393-409, October 1948.
112
Crawford: What was the treatment?
Blum: Well, it depended on what form or stage of syphilis a patient
showed up with. Penicillin was just available, but the older
cases had all gone through the arsenic or arsenic plus bismuth
treatment. There was more than one version of arsenic. If one
had ocular damage, which was not rare, one was treated with
another kind of arsenic. That arsenic, of itself, was
dangerous and it commonly caused loss of vision, too.
So if you saw the patient after they had such treatment
with bad results, you saw the blank nerve heads when you looked
inside the eye, yet you couldn't tell whether it was due to the
arsenic or the disease. That was tricky therapy. One had to
know a lot about eyes. One also [had to know] a lot about
heart disease, and one had to know a lot about other nervous
system problems if one was going to treat cases of syphilis.
Syphilis just caused all kinds of hell--bone disease,
tumors, all kinds of unexpected pathology. The tumors
fortunately would dissolve away with drug therapy.
So that was the research project. We had hundreds and
hundreds of patients: treated and not treated. It was a
respectable study. I learned something about research methods
at that point, and a lot more about internal medicine as a
practitioner.
Crawford: What year are we talking about?
Blum: 1946-47. We residents in medicine had a small journal club-
nothing like the kind we had at Hopkins where the whole
department came--but this was just the residents. There were
some remarkable people amongst those Stanford residents, some
of whom I'd already met, one of whom I'd worked with at
Hopkins. We were a fairly diverse group of about a dozen who
met once a month for a long evening, and would review the more
interesting journal articles that we had found. But it wasn't
the high-powered operation that I was used to at Hopkins, where
the chief of the service was there, too, which kept everybody
on their toes.
Crawford: Is that East Coast versus West Coast operations?
Blum: No, it's just that Hopkins was a big, ultra-scientific
operation; and the West Coast operations were poor, piddly, new
little places by comparison. UCSF and Stanford, in those days,
were not very much by Hopkins standards. They had a few famous
113
people, each of them; but they didn't have the huge faculties
or the facilities, equipment, residents, and researches.
Crawford: And the clientele was different, wasn't it?
Blum: Well, no. It was primarily desperately poor people in all
these university settings. In addition, well-off and famous
people came because they were referred from practitioners for
care that was only available at university centers. Very
similar in that sense in all these institutions, the wealthy
got care on the private wards, the poor on charity wards.
For example, when I was at Stanford, Thomas Addison was the
chief of kidney disease—world-famous, the best-known name in
the field. When he got sick and developed a serious problem,
he went out in the wards with the poor people. The faculty
hated him for that. [laughter] He was an old-time liberal.
Crawford: You would have done the same thing.
Blum: Might have. It wasn't a big gesture, but it was certainly
heartening to the patients.
Crawford: Everybody hated him for that? You mean the staff.
Blum: The staff, yes. "That bastard," you know, "putting on a show
like that." But he probably felt that this is where he got the
best care. The residents, who did most of the care--some on
the private side but mostly on the clinic or poverty side—were
the same residents, but they probably got raked over the coals
harder on the public or clinic side; because there, where
chiefs did make rounds, they didn't hesitate to tell the
resident that they didn't do this right or that right.
The clinic patients were really subjected to the closest
kind of scrutiny. That's where the medical students trained,
that's where the interns and the residents trained, and that's
where a whole retinue of big-shots would come by on rounds,
which took place at least once a week, and, on most services,
by the chief once a day.
So there was the feeling that there might be some risks
there from more mistakes made by trainees, but overall patients
would get better care.
On the private side, the physician in charge of the case
would come through, and he'd trust to the resident, and maybe
there wouldn't even be any interns or residents on the private
114
side. At least this nephrologist , Addison, made it clear that
he thought the clinic side was the best side.
Crawford: And he survived?
Blum: Oh, he survived. I think that he wasn't alone in his thinking.
A lot of people felt that the clinic side did very well, but it
is true; a patient there was exposed to more novices. It might
be where the trainee couldn't hit your veins, or if they did a
spinal tap, they would spend twice as long getting in.
Trainees also go home and crack the books because tomorrow
when they make rounds, they've got to know everything which
might set a new light on the case. I remember about the first
week I was there at Stanford, Bloomfield, who was the man who
brought me there, was the grand old man on the West Coast for
internal medicine. He made rounds on the clinic patients every
Thursday. Sometimes a hundred or more doctors would be there
from all over northern California. This was a famous event,
making Grand Rounds with Bloomfield. It would fill up a whole
ward with people trying to see or just even hear what was going
on.
Crawford: What was that like? Describe that.
Blum: Well, he was an older man, a bit bent, very scholarly-looking,
bald-headed, with glasses. The patient had been carefully
worked up by the intern, and a resident, and a senior resident,
and the chief resident, you know. Then god knows how many
other physicians had seen this poor patient. This was on the
teaching side, the clinic side. Bloomfield would ask for a
recitation from some of these people to tell him what the case
was about, what had been learned, the tests and their results.
Then he would develop the data and go to the heart of whatever
the critical issue was.
It was never a simple case. He didn't bother with simple
ones. He might examine the patient. He was not, in my
opinion, a great examiner. He wasn't good at physical
diagnosis, I didn't think. What he did was use his wits.
When he heard what a good resident had found, he'd start
putting the odds together very scientifically, as though he
were a computer, you see. He'd say, "Well, this kind of rules
out this, and this kind of brings this in." Even though he
examined the patient, that wasn't where the action was going
on. It was going on in his head, and his diagnoses were
famous. He'd find the answers in a real haystack; but it
115
wasn't because he saw the needle by looking at it or touching
the patient. It wasn't that kind of skill.
The first time I went, there was a wonderful and famous
European radiologist, Windholz, in attendance. Stanford
radiology was always great, and this man was a refugee who had
come to the top x-ray department in the U.S.A.
II
Blum: It was Bloomfield's show, but Windholz was also a prima donna,
and a superb one. As they went through a case, sometimes
Bloomfield would turn to people and say, "What do you think?"
if it might concern their specialty. Thus he could get more
ideas before he'd finally pronounce; and I don't think he
called on Windholz. Windholz was just standing by the bedside,
though, as a very senior man. When Bloomfield got all through,
Windholz said, "Did you look at the patient's neck, Doctor?"
And here were these great big old tubercular scars, and that
was the key to the case. This was not appreciated at all.
[laughs]
Crawford: How was this handled?
Blum: Well, you thank goodness that the good Lord sent Windholz to
tell you what the answer was, but if the chief never saw him
again, it would be too soon. The next time we made Grand
Rounds, I remember Bloomfield saying to him something to the
effect of, "I'll call upon you if I want you." [laughs]
Crawford: Keep your observations to yourself.
Blum: But it was done decently. I don't think anybody snickered,
except maybe a few of us residents. Windholz was a superb man.
I remember he died that year. All of a sudden, a vicious
cancer. It just carried him away. I became very fond of him.
We had encountered patients together, and I was one of the few
people that enjoyed him, his brilliance, his remarkable
experiences, and kept visiting him as he was dying in the
hospital.
Crawford: Was it a very grueling schedule?
Blum: I didn't think so. I loved it. You were doing what you should
have done, and that is a careful job of examining patients,
studying medicine, and doing your research.
They didn't have anybody there to do cisternal punctures in
the clinics, and I'd learned how to do that somewhere along the
116
line—in Arkansas, no less. Sometimes one couldn't get spinal
fluid out of the spinal column. Some people had back injuries
so bad that their spine was all messed up, and one couldn't
find a place to go in to get to the spinal fluid. This spinal
tap was always done for syphilitics to see whether their
nervous system was being affected. In these different cases I
did the cisternal punctures, which required putting in a long
needle at the base of the brain, to get spinal fluid to test.
That was quite awesome to observers--! was glad I was trained.
I'd be scared to death to do one again.
Crawford: How did you learn that?
Blum: In Arkansas, just by watching. You watch one, and then you do
one. [laughs] How else can you do it? An expert is sitting
there guiding your hand, saying, "No, no. Tilt the needle this
way, or that way." You're pushing the needle in, and you're
waiting for a feel of going through the outer lining, which is
kind of the tough one; and then the inner one, which is
delicate and easy to go through. Then you're in. Your needle
has a plug in it, so it isn't open. You pull that out, and
then fluid starts coming, and there's beautiful, clear fluid,
and you capture it for the test.
There's a limit to what area of the spinal cord you want to
tap. You always go in where the spinal cord has ended, to the
lower three or four inches of the spinal column. In a
cisternal tap, you're right up against the base of the brain
where there is a pool of spinal fluid, which lends itself to
tapping. However, I heard after I left Hot Springs that they
had stopped doing them. I said, "Why?" We used to do twenty,
thirty in an afternoon, lined up the patients and one of us
would get there and do them.
Well, two patients in a row had perished. Somebody was
going in too deep and hit a blood vessel, causing a hemorrhage
at the base of the brain. Perhaps if there were a good
neurosurgeon, I think they could have done something about it,
but they didn't have any neurosurgeons . So there were some
drawbacks. I'm not sorry that I didn't keep on doing that for
a living. Anyway, residents had moments when they were
obviously smart and knew how to do something that nobody else
did. Other than that, it was just a high-quality operation and
you weren't expected to do heroics. We got a lot of referrals,
but the bulk of the clinic patients were ours- -our own
patients, and we proceeded to the limits of our skills, which
were being extended by with every new case.
Crawford: And you lived where?
117
Blum: Oh, ten, twenty blocks from the hospital; on the Mission side,
near Mission Dolores.
Crawford: Where was the hospital located then?
Blum: Stanford? Where the California Pacific Medical Center is now.
Crawford: That's what I thought, but that was a long walk.
Blum: I didn't walk. The streetcar would take me across town. I may
have walked home sometimes after the day was over. That was
kind of fun. A former classmate of mine at UC was living right
near Stanford and was a resident at UCSF. So I'd go by there
and see him and his wife if I got off early. He and I
generally compared notes about what we were learning and how
life was treating us. He didn't get his promised payments at
UCSF after all, but he did get his laundry done. That's all he
got. I was earning real money. I forget what it was, but it
was over two hundred dollars a month.
We would trade stories about our residency. I was so
pleased with where I was, and the people that were around me
were so nice to us, and he was still being treated like dirt.
He became a very fine orthopedist.
I'll never forget one day he said, "You won't believe what
I went through this morning. We have a resident who put the
pictures of the legs of a patient upside down in the viewing
box." He said, "You know, there's nothing wrong with putting
them upside down, but whoever studies x-ray pictures upside
down?" [laughter] He said, "I can't believe it. This guy is
a senior resident," and I guessed who it was. He said, "How
did you know?" I said, "Well, there was only one guy that lame
in my class." That had to be him.
Crawford: Well, so you finished your residency at Stanford?
Blum: Yes, and then it was a matter of, "Where do I go from here?"
The resident that I had met at Hopkins during the war- -we
worked in the same service- -was leaving Stanford also. We
decided that maybe we would go into practice together in Palo
Alto. He had his eyes on glory and wealth. I never focused
well enough, I suppose. So we thought through the whole
business of how we were going to run our affairs as the best-
quality practice in town. Then the opportunity came for me to
go to the School of Public Health at Harvard.
118
Harvard University and the School of Public Health
Crawford: How did that happen?
Blum: Well, as a matter of fact, while I was exploring the Palo Alto
situation—and we would both get teaching appointments at
Stanford—life looked kind of rosy. But I still was thinking
about living in the East Bay and opening an office there
because we'd spent many years there. So I went to see a man
who ran the clinics for what was then the Oakland Health
Department. I said, "I'd like to work in some of the clinics."
I'd do the VD clinics, immunization clinics--! wasn't going to
do any pediatrics or obstetrics. I was exploring the options
for being on my own and needed income while I built up a
practice. He said, "I'd be happy to put you to work in the
clinics. We can find a place for you so you could start a
practice. But you've done this, you've done that, some in
public health- -why do you want to go into practice? Why don't
you go into public health?" I said, "I've thought of it,
really. It's kind of been my long-term direction, but, then,
on the other hand, this past year all I've done is clinical
medicine." Well, for two and a half years, really: Hopkins for
a year and a half, Stanford, a year. "Why don't you think
about it?" he said, "I went to Harvard School of Public Health,
and 1 loved it. I had a great time there, and I've done public
health ever since, and never regretted it." He didn't have the
internal medicine training I had, but he'd been trained in a
general way. He said, "There are openings coming for
physicians at your level who will be paid to go to the Harvard
School of Public Health for a year. You can earn a master's
degree in public health, and then you can do what you want.
When you come back, you can still go into practice, if you
still want to, but you could also go into public health, here
or elsewhere."
That was the fork in the road. I had to make up my mind.
The other resident said, "Well, I'm going to Palo Alto to set
up practice, and if you're not coming I'll just forget about it
and do it on my own." And he did. He went there on his own,
and I succumbed to the lure of Harvard and public health.
I had an interesting year there. I also worked in the
clinics at Peter Bent Brigham with internists there, and had a
great time. They were very, very nice, but I was already
clearly a physician who was coming back for a year at Harvard
School of Public Health.
Crawford: What did you get out of Harvard?
119
Blum: The degree, a master of public health, in 1948.
Crawford: Yes, but what hadn't you known?
Blum: Oh, I didn't really know anything about public health. My
exposure to public health as public health was a bit of a joke.
I had prison experience, and research lab experience, and this
one year in San Diego in venereal disease control, but really
never learned any basic public health. The intern year in the
Marine Hospital was all medical practice, a general rotation
from ENT to OB/GYN. But the stuff I got the most of was
medicine. Hopkins was all medicine. So I really got no public
health training.
At Harvard the first thing I discovered was that I had a
co-worker from Hopkins. She too was on the faculty at Hopkins
when I was there. Her name was Bowditch. Well, that's a great
name at Harvard, also at Berkeley. She was a lovely person,
not married. She was a true Boston Brahmin and had just moved
back to her home on Beacon Hill the same year that I ended up
there as a student. She also was taking a master's in public
health. She already had her boards in internal medicine. At
Hopkins we'd met one another, but here we became closer as
classmates. Faculty wouldn't let either of us take a couple of
courses at Harvard School of Public Health because the
instructor said, "You know too much about the subject matter,
and I don't want to put up with that sort of a thing." [laughs]
Crawford: What was the course?
Blum: It was about control of venereal diseases.
Crawford: You were somewhat of a reigning master.
Blum: Well, not so much. I knew the clinical side, but not the
public health side. The professor didn't want us in class.
Harvard was a great place, and in my class was a lady
physician who ultimately became my assistant in the Health
Department in Contra Costa County for maternal-child health—a
Japanese lady, a fantastic history, Yoshiye Togasaki. She's
still alive. She was a bit older than I. She was from a
prominent Japanese family. Her father was a minister- -
Presbyterian I think—and the mother was one of the first
suffragettes in Japan.
They were a San Francisco family, or Berkeley /San
Francisco, and had quite a name here. One of her brothers was
a manager or president of the Sumitomo Bank here, and another
120
one was the manager of the Nippon Times in Tokyo. This was a
very hardy group of folks who had had all kinds of advantages.
My classmate had gone through Cal and then did her M.D. at
Hopkins. She was subsequently trained in pediatrics at USC or
UCLA in Los Angeles. When the war came along, she was put into
one of the Japanese concentration camps. She had just opened
her office and everything she owned subsequently disappeared.
She had two sisters who were also doctors. One was known
as the Angel of Buchanan Street in San Francisco. She was an
obstetrician. The third sister was, I think, also a
pediatrician, practiced in Hawaii when I knew her.
Crawford: That's remarkable: three sisters.
Blum: Yes. The fourth sister was the head of nursing at a huge VA
hospital in New York. These were fun people. I got to know
them very well.
Yoshiye, my classmate at Harvard, had Boston connections-
she lived in the home of a lady who was a Lowell and a Cabot--!
mean, one of those Beacon Hill families. We occasionally went
there for dinner. These were old homes that have a certain
elegance about them, so we thought we moved in good company in
sort of a second-hand way.
We once went to an open house on Beacon Hill. We thought
it offered one way of seeing how other people lived. We'd seen
two such homes previously, but that wasn't very much. So we
paid--I don't know—six, eight, ten dollars to feed the
starving Bryn Mawrians. As I remember, that's what the
collection was for, and we got into some really wonderful
homes .
In one, the lady came to the door--a brisk lady, striding
in fairly short skirts. She was an interesting, pleasant-
looking woman—but she didn't look Bostonian. She began
showing us around the place, and everything about it seemed out
of keeping. We were with another person on this tour who was a
San Francisco interior decorator—one of the first gay people
that I'd really ever known. We became rather close friends
because he was an enjoyable person. "This fireplace we redid,"
she said, and he's down on his hands and knees, feeling it.
Well, they had painted it to look like green marble. It was a
fake.
Crawford: Marbleized.
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Blum: Yes! This is an old Beacon Hill home. A showplace on Beacon
Hill. Next we go out in the backyard, and it's one of those
small Beacon Hill backyards, Louisburg Square, and it's just
about the size of this room, maybe a little deeper. There is
almost no garden there. This is in the spring, and the walls
are all painted in azaleas and camellias. [laughs] It turned
out our hostess was from out West and she was just having a
great old time terrorizing the natives, I'm sure. You just
don't do things like that on Beacon Hill.
Crawford: She made a reputation for herself.
Blum: Reputation for sure, but she was on the tour, so you can
imagine her status, that in spite of all the monkey business,
she was on the tour. Well, that was part of going to the
School of Public Health. We didn't kill ourselves there.
Crawford: Did you have a lot of statistics?
Blum: Yes, a beautiful course. That's one of the best courses I've
ever had. I really learned a lot of statistics there. Or do
you mean statistics about the school?
Crawford: No, the course.
Blum: Oh, it was excellent. It had always been superb, and it still
was. They didn't waste any of our time making us do all the
mechanics of additions and subtractions and running through the
statistical formulae. What they did was what should have been
done at any other school. They gave us a series of articles
that were out of the best journals — the best statistics — and
they said, "Go through these and see what's right and see
what's wrong about the premises, the methods used, the
conclusions drawn."
One learns right away that many of these great articles
were garbage. The way they assembled the numbers—well, they
weren't the right headings for the numbers, or the researchers
had lumped things together that were not lumpable. On and on
and on, very basic stuff, so that we acquired a new respect for
statistics, and even if we weren't going to be statisticians,
we could start looking critically at work when we read the
literature.
So we had a wonderful program in statistics. And we were
left to study what we wished. That was the beauty of Harvard.
You don't have to do something because it's required. If you
don't need it, don't do it.
122
Crawford: So it was a fruitful year?
A Special Bostonian Family
Blum: Oh, it was a good year in many ways. I also made some
remarkable acquaintances. We couldn't get any place to live
initially. It was right after the war was over. We'd heard
from the previous class about a medical student who lived in a
great big old house up in Brookline. It was a three-story
mansion built by some old-time gambler. The current owner does
not live there and wants to rebuild the place into a nice home
for one son, and has another house she will rebuild for her
second son, the medical student.
Blum: Currently each of her two sons has one floor and there is an
attic- -a huge one with a bathroom that has been let to SPH
students in previous years.
The student's mother owned and operated a big clothing
factory. One year they'd be millionaires, and the next year
they'd be broke; a fascinating, big-city Jewish family. When
things were going good, she'd send a thousand blankets to
Israel or something like that.
"She just doesn't want anybody to come in the house," the
medical student said. "I'd be perfectly happy to have you. I
live on the ground floor, and my older brother lives in the
next floor, but I just can't do it; Mother is starting to
rebuild." So we looked and looked for days, and we finally
came back and rang the bell; and there he was again. School
hadn't started yet. He was still in his bathrobe, and we said,
"Gosh, can we just stay here as long as we can, until the
rebuilding starts? We can't find a place—nothing. " "All
right," he said, "all right, let's find my mother." And he
gave her a story about these poor, starving Calif ornians--he
turns out to be a real character—and they have no place to
stay. So she didn't even realize she was going to get rent
from us; she thought she was putting us up, that appealed to
her.
The medical student son was quite the storyteller—a real
Danny Kaye-- looked like him, acted like him--a tall, gracious,
handsome fellow. He had just finished his first year medical
school, and he had won both first year prizes at Harvard, so
123
you know the kind of character he was. He'd come via Purdue
where he'd been an engineer, summa cum laude.
His mother's home was there in Brookline, which is right
next to the medical school, and he thought, "Maybe with my
engineering, I should go into orthopedics." He went over to
Harvard, and talked to them a little bit, and they said, "Well,
why don't you come in in the fall?" None of this crap about
have you had biology, and haven't you had Shakespeare--just
another world from Cal. There's a difference. They're not
number two and trying harder, they're number one. They don't
have to try harder.
He came in, won both their awards for freshmen students.
When I was there as a student in the School of Public Health,
he was a second-year medical student. For the fun of it, many
nights we'd spend hours going over whatever he was doing. It
kept me refreshed. It probably didn't do him much good, I
don't think he needed much. Well, he went on to be the first
Jewish resident in surgery in Harvard.
Crawford: At Harvard?
Blum: At Harvard, at the Mass. General Hospital. He was something
else. His name is Glimcher. He's chief of Orthopedics at
Harvard today.
Crawford: Is he really? How do you spell his name?
Blum: G-L-I-M-C-H-E-R. His youngest daughter is now a full professor
in the School of Public Health and Medicine in immunology.
They're bright people — and fun people. Years later he would
come out here for the orthopedic meetings, and we'd get
together. He might be asked to do a four, five, or six hour
session on all the new information for the nation's
orthopedists.
Crawford: Still head of the department.
Blum: Still going strong, yes. He did some fantastic work when he
finished his residency, for which everybody thought he'd get a
Nobel Prize. He never did, but I do remember his being invited
to Russia to lecture on the formation of bone, which was the
research area. He learned Russian in six weeks at a cram
course, and he gave his lectures in Russian.
Crawford: Oh, that's unbelievable.
124
Blum: It was frightening: tremendous, rampant brilliance. [laughs]
Plus, he's such a gracious, determined, handsome, fun person.
I remember when we were living in his house up in the garret,
which we converted into about four rooms, including a bathroom
with an ancient old copper tub which had the seams in the
bottom.
Crawford;
Blum:
He came home one night. He'd gone to see a movie, and I
don't think we knew about it. He came into the room, and we
knew exactly what it was. The way he came in, he was the
horses prancing on Queen Elizabeth's coronation carriage. He
could convey the royalty, the horses, the carriage, the
ceremony of her procession. He was another Danny Kaye.
That was quite a household. His older brother wanted to be
a doctor, and was a tremendous salesman. He worked in the
factory for the family. If ever his older brother felt
depressed or ill--he was a huge man--he got into his hospital
bed and we knew that Norm wasn't feeling good. He wouldn't be
in his regular bed. [laughs) It was a medicalized household.
They took care of us. They gave us overcoats, and they
gave us clothes. Here were these poor starvelings from
Calif ornia--we were kind of a decoration—that ' s us, these poor
devils from California. But in moments of reality, they knew
quite well that we weren't any such things, just students at
Harvard.
Your wife enjoyed this?
She got a kick out of it, yes. It was fun. It was great fun.
I do remember we had this horrible car: the only one we
could get at the end of the war. It was a Hudson we bought in
San Francisco. It was cheap enough, but it was a piece of junk
as it turned out. They told us, "You can't go over thirty- five
miles an hour because we have a governor on it." I bought it
when I was at Stanford as soon as we came back from the
service.
After we'd gone our thousand miles, we went down to have
them take off the governor. They told us, "Oh, well, there
really isn't any governor on it. It just won't go more than
thirty-five miles an hour." [laughs] We got it back to
Boston, and getting it back home was even worse. That car was
truly a nightmare. In Boston we kept it parked in front of our
house, and of course it had California license plates on it--
and to see the kids pet the car--I never got over that.
California had that kind of magic about it.
125
Crawford: Oh, it was California that did it.
Blum: The California license. They were petting this horrible old
Hudson.
Crawford: What was special about California?
Blum: Well, it was the dream. It was the Golden State. It wasn't
just the Chinese that called it Gold Mountain. It was kids in
Boston. Your car would not be damaged. Kids would come along
and gently stroke it.
Crawford: And did you experience that too?
Blum: Yes. We were from California, and that didn't do any harm.
Getting our attic was just such a fallout.
Crawford: It sounds like a wonderful time.
126
VI SETTLING IN CALIFORNIA- -CONTRA COSTA COUNTY: 1950-1966
The California State Health Department; A Year in San Diego,
and on to Contra Costa County
Blum: When I came out of the Harvard School of Public Health in 1948,
I worked in the State of California Health Department for a few
weeks because they had sponsored me at Harvard. They sent me
around the state doing odd jobs. I ran the health department
in Tulare County for three weeks while the health officer took
a breather. Then I went to San Mateo County. They had a
health officer, but not an assistant. So I was there for some
weeks as an assistant.
Then I was sent to a meeting of all the health departments
in California down in Long Beach. I came in late, sat down in
the dark next to Alex Lesem, the health officer of San Diego
County for whom I'd worked when I had been in the service two
years previously. He was an old fidgety man. He's fidgeting
around, and he leans over and pulls my badge about to see who I
am. He says, "What are you doing here?" I responded, "I'm in
the State Health Department, returned after a year at Harvard."
He said, "Let's not waste any more time. Let's you come down
to San Diego and be my assistant. I'm retiring in two years.
Then you can have my job." So I went out and told my wife
about it. We both loved San Diego, although there were some
problems about it. We knew that we would always commute from
there back to the Bay Area to see friends and so on.
Crawford: Her family is here, as well?
Blum: Yes. But, in short order, we moved back to San Diego, but only
for another year, as it turned out. This year I was number
three person in the department. The health of f icer--this old
man who thought I was such a good guy, and his current
assistant director, an Indian, pure-blooded American Indian
127
from Oklahoma, well trained in public health- -and myself,
number three. It was a big health department.
For the fun of it, on the way home back from Harvard, I got
a short hair cut, which I'd never had before. I also bought a
bow tie and a pair of suspenders to hoist up my trousers. It
was intended to be kind of a joke. The Indian who was chief
assistant always wore bow ties. (He had also gone to Harvard.)
It turned out that the old man hated bow ties; just couldn't
stand them. I guess I had luck enough not to wear the bow tie
to work the first few days. He said, "Do you know? That chief
assistant of mine wears bow ties. What kind of a pimp is that?
The only people I ever saw wear bow ties in Indiana were
pimps." He had grown up in Terre Haute. [laughing]
Fortunately, I was not wearing my bow tie, and I never did wear
my bow tie in San Diego.
The chief assistant realized right away that our boss was
undercutting him. The boss turned to me to deliver all the
messages for the department, and I'd have to go back to the man
above me who was really the chief assistant health officer and
let him know what was going on, tell him, "The old man wants
this or wants that." We got along, which was surprising
because there I was, being set up to take over his job.
As I got into the job in 1949, a great polio epidemic was
underway in San Diego. Every day I'd make rounds on all the
cases in the county who were cared for on the isolation ward at
County hospital. Although this wasn't my assignment, I took
care of every one of the 360-plus cases that occurred. We did
everything, iron lungs and all. We wrote an article about
everything we learned.1
It was when polio was just unraveling. Bill Reeves, now my
next-door neighbor, and one of his sidekicks were unraveling
the mysteries of why our people, Americans, tended to come down
with polio in countries where there didn't seem to be any polio
cases. Well, it turned out that countries without polio really
were riddled with polio; they had been infected in infancy, had
passed through it, and were immune. Our troops, in a country
that's fairly clean like the United States, had never really
been exposed to polio, and so as adults placed in backwards
countries they were getting heavy doses of polio virus. In San
Diego we backtracked every case to where it came from, where
'Blum, H.L., W. Chiapella and A.W. Lesem. "The 1948 Epidemic of
Poliomyelitis in San Diego County, California." Stanford Medical Bulletin
7:4, 169-179, November 1949.
128
they lived- -and lo and behold, the bulk of these cases occurred
in new San Diego neighborhoods. San Diego was rebuilt,
practically, during the war, and this was at the end of the
war. These were people living in new neighborhoods that didn't
exist before; but if you went one step further in checking on
the victims, which gives you an idea of the pitfalls of
research, it turned out these were typically longtime residents
in those new neighborhoods.
The new neighborhoods were composed mostly of migrants from
all across the country—disrupted people, families, and kids.
So it was more likely to be members of old families who had
already been there who got new exposures, and the new ones were
really not at as much risk because they had been infected early
in life. At the same time, we took care of the two cases from
Tijuana. Tijuana was a tenth the size of San Diego, and should
have had at least thirty-six cases, and they had two cases.
Tijuana's a destitute place, you know, poor and dirty,
unsanitary.
Crawford: They were immune?
Blum: Yes. But the two kids who
wealthy families. They had
started learning kind of by
care of the cases—you know
respiratory paralysis cases
got three hundred and some
all kinds of polio that you
they were clearly polio, at
got sick with polio came from very
been protected too long. So we
accident. I learned how to take
, used respirators for the severe
We did everything. When you've
cases, you're in business. We saw
never read about in books. Yet
the middle of an epidemic.
It turned out that, before the year was over, the old man
put in his bid for retirement, and the county opened up the
exams and I was not yet qualified for his job— plain and
simple. I didn't have enough experience. The chief assistant
had to have two or three years. I didn't have it. I had a
master of public health. So did the other candidate, also from
Harvard, but he had the experience. That was that. So he got
the job, and we were all happy.
He was a nice person—never held the boss1 favoritism
against me. The old man had his quirks. The new director
offered me his old job. I'd move up and be number- two man
under him. I thought about that for a while, but we were
getting a little tired of San Diego because our life was up
here. It was kind of crazy, and San Diego is not an easy place
to get into things. We got involved with a little theater, and
we got into this and that, but organizations wouldn't look at
you if you were a newcomer. They were so used to the service
129
Crawford:
Blum:
people—in and out. They thought they were wasting their time
and money on transients. We thought we'd settle there at first
and so we started joining. In the long run they did waste
their efforts on us when we decided that we really didn't want
to stay in San Diego. It was beautiful, but not for us.
Then I applied for jobs — for the one in San Mateo and the
one in Contra Costa. San Mateo was being the assistant—chief
assistant—and Contra Costa was being the health officer. The
health officer in San Mateo met my wife in the parking lot one
day and said, "Where are you going to live when you come here?"
Because he knew I was applying for the job. She smiled, and
she said she loved the Peninsula and would be happy to settle
anywhere. She hadn't picked anything out. It was very clear
in her mind that he was saying, "You'll be here shortly." Then
he picked the lowest-rated doctor on the exam list, dead last.
He never spoke anywhere about anything in the twenty or so
years he was in the job.
What do you mean, never spoke?
He went to meetings and we never heard from him. He had worked
with the health officer in a previous job, so the health
officer knew perfectly well what he was like. To take a risk
on me, I guess, would have been crazy, but to go through that
fraud with my wife was kind of pathetic.
The head of the school of public health here, Chuck Smith,
was a world-famous public health figure, and he sat on the
selection committee that picked out the people to go to San
Mateo, and he picked me as number one. So everybody else on
the committee went along with that- -number-one candidate. When
I didn't get San Mateo, at the same time, more or less, they
were selecting the health officer for Contra Costa. Dr. Smith
was on that committee too. As the dean of the SPH, he was
everywhere. He was quite a scientist as well as being public
service oriented.
So he picked me again as number one for Contra Costa. That
job I got. They didn't need as much experience, they weren't
as fussy as San Diego. It was a kind of a cow county. It had,
historically, a horrible health department. I was told that if
you go out there, you're going to wipe yourself out. You
shouldn't even go. If you take the job, for goodness sakes,
don't make any moves. Just take it easy because the same man
has been on the board of supervisors for over forty years, and
has been chairman for twenty-four; and he doesn't go for public
health. So take it easy. This was advice from the state
health department.
130
Crawford: Who was the chair of the board?
Blum: Billy Buchanan. He was a stocky old Scots fellow who ran a
grocery store up in Pittsburg: a straightforward, straight-
shooting guy, but so ancient. He didn't believe in newfangled
crap like public health, but state law said he had to have a
health department, so he had one. He ran the board with an
iron fist.
Crawford: The board of supervisors?
Blum: Oh, yes. He was chairman of the board. So I got picked. One
other person on the selection committee was the head of
personnel for Tidewater. I guess that's Tosco now. Tidewater
was a big oil company. The county administrator was also on
the committee. He wasn't the administrator then--he was the
county auditor, sweet lovely man. I got the job, and I came to
work for Contra Costa County, and I wasn't sorry. I was sorry
to leave San Diego in some ways. It was so beautiful. We
lived near the water: a block from the ocean. The climate was
out of this world. We had quite a love affair with it because
our last station in the Public Health Service had been in San
Diego.
Crawford: So you had some connections?
Blum: Yes. I knew everybody there in the health department, and
finally a lot of other people, too. Well, not a lot, but some.
We really loved the place, but it wasn't where our life was--
all of our friends were up here.
Serving as County Health Officer in Contra Costa County
Blum: I came to Contra Costa and could find no place to stay. (We
ultimately found a motel with a vacancy in Lafayette in
February.) Some people met us at a party. They were just
youngsters; he was getting a degree here at UCB. They said,
"Why don't you come and stay with us. We have a place in
Berkeley." So we stayed with them, and that was really funny.
They were total New Yorkers, and they had picked some poison
oak, and it was on the mantlepiece--beautiful leaves, you know.
They were always having these outbreaks of horrible skin
disease, and it was, of course, poison oak. They were just
keen, lovely people.
131
Crawford:
Blum:
Crawford:
Blum:
Crawford:
Blum:
Crawford;
Blum:
She came from a well-known family, and he from not so well-
known family, but a fun character who'd fought his way up
Montecasino for a year in World War II. His squad lived in
tombs--hollowed-out tombs--on Montecasino--were held up there
for the best part of a year. A fantastic sense of humor, which
I guess you'd have to have, if you lived in graves; and always
watching out for the mailman to make sure you wouldn't shoot
him. He'd bring the mail every couple of days while they were
lying in these tombs and slowly inching their way up the
mountain. A tremendous casualty load.
Finally, I can't help but think of these people as so sweet
because they housed us, and that started us off right. Then we
found a little house. Bishop's Better Bungled Buildings, as I
remember, we used to call them.
What did you call them?
Bishop's Better Bungled Buildings. The builder had some sort
of B-B-B moniker. He wasn't very good, and things would always
go wrong in these little places. We found the little shack; it
was fairly new and on the main drag between Martinez and Walnut
Creek. We decided to live in Walnut Creek, and the office was
in Martinez. The reason for it was pretty straightforward. As
soon as I came to Martinez, I discovered that I was going to be
asked to join the Rotarians, the Kiwanians, the Lions, every
little social circle, the bridge club. I just couldn't live
that way. There's no way I could socialize and enjoy the
prominent citizens, lawyers and doctors, in town. That's not
living to me.
In Martinez?
In Martinez. So we discovered that if you lived in fast-
growing Walnut Creek, you belonged to nobody. Walnut Creek was
the home of everybody and nobody. Yes, there was a little
ancient inner circle, but most people were newcomers and had
ties elsewhere, at least initially.
Why was Martinez so social? It was, I guess, the county seat?
It was the county seat. If you were going to live there and
had an income, a title, so on, you had to fit in to a
relatively stable little town with a life of its own.
You didn't like all that socializing?
Well, the people were small-town people. Some of them became
important jurists, but they were not our kind of people. We
132
Crawford:
Blum:
didn't have trouble with them, you know, but in Walnut Creek we
were left alone. Since we worked in Martinez, that kind of
dismissed us. Walnut Creek was full of strangers. In Walnut
Creek, we were in a crossroads. Well, it wasn't even a
crossroads. It was a dead-end road. Highway 24 dead-ended in
the middle of town, when we came there. Our friends were
wherever we had made them, and of course, we did make many in
Contra Costa County and many in Walnut Creek.
We ended up living very much in Walnut Creek, and that was
the beginning of, probably, our most fun years, in many ways.
I was the health officer, and knew from nothing. We had had
two years in San Diego, thank god, where we had a heavy
exposure to all kinds of situations. We had the international
border, we had the navy, we had the aircraft carriers, we had a
lot of Indians, and we had a lot of problems. So in a sense we
were a lot more sophisticated coming from there where they had
big problems all the time. Contra Costa was kind of a suburban
bedroom community then. There weren't the big office buildings
that are out there now.
There was the strip of heavy industry all along the
waterfront. That was something we really hadn't dealt with in
San Diego. Heavy industry really called the shots, you know,
very much so because they were staggered along the waterfront
and they were in almost every supervisor's district with one
exception. Industry had plenty to say and had something to do
with how the supervisors voted.
How did you begin in Contra Costa?
We were welcomed in Contra Costa by a lady with whom we also
became close, who is now in her mid-eighties. She was a very
regal-appearing person with a wonderful hair-do, a good robust
figure, and well dressed, a smart person. Then she was in her
forties, and she was the president of the Tuberculosis
Association. It was the big voluntary health agency. They
decided since they had such a terrible health department — and
they did—they were going to do something about the new era.
She didn't know me from the man in the moon, but she
undertook to have a welcoming party for the new health officer.
It was held in the C & H Auditorium, Californian and Hawaiian
sugar, in Crockett. There were hundreds of people there and
everybody welcomed me and my wife, like we were closest of
buddies. That's how we started.
Crawford: Who was she?
133
Blum: Helen Vurek. She worked in the post office in Orinda, and knew
everybody that lived in Orinda because she was the mail person
there. Her husband George was an artist, but during the
Depression he turned into a pattern maker, which takes good
artistic skills. He had a big pattern-making shop in San
Francisco--the kind that builds propellers for ships — and in
his spare time did art things. He was that kind of person who
could do things accurately to the nearest thousandth of an inch
if it was needed, but beautifully, too—beautiful work. So
they had a good, basic business. They weren't rich, just
basically well off. They had a son who was just starting
Caltech to be an engineer. He's already retired.
We were suddenly part of their circle. They were amongst
the most gregarious people that I ever met. They were liberal
people, well read, even though neither had been to college.
They knew more than most college people that I knew; they were
just up on their toes. They went to something every night: a
lecture, a play, an opera, a concert. We never could keep up
with them. They've been everyplace in the world. In fact, we
just had dinner with Helen a night ago; George died about two
years ago.
So we were thrust into a kind of a ready-built group, and
most of them were similar kinds of people. A Supreme Court
judge, Ray Peters, was one of their old intimates, a wonderful
man. I don't know if you ever heard of him, but he was one of
California's great Supreme Court judges. Right away, we
started meeting all these people. These are your friends, you
see. That was kind of fun because I think we could have met
these people only very, very slowly, if ever. They were not
just Contra Costans. They were in San Francisco and the
Peninsula. They were in Marin. Their folks or friends were
scattered all over--it was a big family.
Crawford: But that meant the community valued you and the position you
were taking?
Blum: Yes. It completely changed the flavor. The previous health
officer never moved a finger. I'll never forget the first day
I came to the office, and here's the director of nurses, who
was a great gal—powerful, big Minnesota lady— and she had her
feet up on my desk— she denies that it was true— but I remember
it. It's just like she lived there, and she did, too. She ran
the health department for the previous guy. There wouldn't
have been a health department if it hadn't been for her.
Crawford: What was his name?
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Blum: I don't even remember. The director of nurses tells me, "We've
got a big clinic tomorrow morning, and you have to give shots."
That was the way it was set up--you give the shots, and they
prepare everybody, and move them along. So I said, "What do we
use for needles?" "Well, in your desk, there are three
platinum needles. And that's the extent of the stock here, and
three syringes to go with it." They were going to do a clinic
of five hundred people. I was kind of baffled; I'd never seen
anything like this. She said, "Well, that's the reason they're
platinum." It's that you can put them in a flame and it
doesn't hurt the needles. They stay sharp. This was
sterilizing. You go from one person to the next. Well, that
isn't safe sterilization because there's often pull-back into a
syringe, and you can get some blood or a little plasma from one
person and you can spread it to a thousand more by using the
same syringe. Really, it's horrible.
So I kind of shuddered, and I proceeded. We went to the
clinic, and I got them to take along a few ordinary needles
that could be boiled and sterilized on the spot, although
boiling is hell on their sharpness. I didn't wait too long
until I completely destroyed those three needles. They're very
delicate, and they kind of crumpled up in my clumsy hands. So
we got rid of the three needles. We didn't ever replace those.
In the next day we bought a couple thousand needles and
syringes, starting to do business. At least you could breathe.
The disposables didn't come in for another five years.
Expanding the Budget and the Department: Testing for TB
Crawford: What was your budget like?
Blum: Oh, it was almost zilch. I don't know. It was pennies. It
was pitiful. It went up spectacularly the first year. One of
my selection examiners, who had been the county auditor, had at
this point become the county manager, Desmond Teeter by name,
and was now my immediate boss. There were about twenty
candidates for the job, and since he had selected me, I had a
buddy in the right spot. He was a nice man, a lovely man, and
inadvertently he gave rise to this medical school at UCB--quite
inadvertently—because of various things that happened out
there. What a small world this is. He kept going to the board
on my behalf. I got there February the first, and the budget
had to go in in March or April. In those days, a county like
that finished with the budget in July or August. Our health
135
department budget went up severalfold over the year. Billy
Buchanan, our board chair, had a heart attack and died.
Crawford: No!
Blum: No. I can't blame it on the budget, but I can't be sure about
that. But it surely happened. And in this turmoil, and with
the auditor becoming the administrator and really running the
county, my boss was this kindly older man. The TB Association
wanted to do a TB survey of the citizenry as soon as I got
there. Chest x-ray surveys were very popular then. Everybody
got a chest x-ray. I had just been in charge of the one in
San Diego, and, lo and behold, the people here were clamoring
for one.
So I got the same team from the USPHS that we had in San
Diego to help run it. I got the same crew and one extra. That
was Leonard Duhl. He and another doctor were sent here by
USPHS to read the x-rays. That's how 1 met Len Duhl. The
survey went so easy and fast that he would spend most of his
time working and doing general public health, not just reading
x-rays. He was here for two years. So we spent a lot of time
together, learning about public health. He was totally free
wheeling, so he could find all kinds of problems and approaches
to them.
Blum: All of a sudden, this TB thing had landed on us and we x-rayed
every adult, and it's a tremendous and very visible campaign.
Crawford: Where does that mandate come from?
Blum: From the U.S. Public Health Service, but to get it meant that
California had asked for it, and the county asked for it. I
thought it hadn't been too productive in San Diego. If the
citizenry are not too poor, and reasonably well-off one is not
going to find much TB that way. TB is going to be in people in
your jails, and in your slums. There were some bad, poor
neighborhoods in Contra Costa, especially Richmond and
Pittsburg--some really ghetto areas. We did those, and a lot
more, to see what we'd learn. We learned a lot of things about
our citizenry, their awareness, their health, their medical
care, and what they thought of county health services.
But I also thought this would double the size of the health
department, which was miserable, and it did. So even though
the money was put up as temporary, somehow it never left our
budget. Our budget just skyrocketed because of the doubling of
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staff. Of course, that earned me the ill will of the
taxpayers' association, and that was kind of an unpleasant
aspect of our department coming of age.
In the course of a couple of years, our budget kept
doubling. The nursing budget brought in all the schools.
There were "only" thirty-four school districts in Contra Costa
County. They hadn't amalgamated yet, and the county was full
of parents, full of kids, and everything seems to be run by the
PTA. What the unions and industry didn't run, the PTA did. So
we dealt with the school districts, and their PTAs, and they
wanted school nurses. I thought that through for a while — that
would double our nursing staff again, maybe triple it.
Crawford: Schools had no nurses then?
Blum: Some schools had a lot of nurses. They wanted us to take over
their nurses, and the ones that didn't have any wanted us to
provide them. I thought, "Now this is kind of dumb. We will
have the biggest empire in this county in short order. We will
be a target forever more — they 're not used to spending this
kind of money on the health department." So we developed a
philosophy--Dr. Yoshiye Togasaki and I, with a few others.
We developed the philosophy that it would be better if
other organizations had the huge payrolls and the huge budgets,
and we would give them professional or expert direction. We
struck up a deal—and the county board wasn't disapproving- -we
would hire another assistant health officer to be in charge of
the school work, another to lead the children's dental program,
and the schools would hire the nurses. If the school district
couldn't afford nurses, we'd put in a minimum of nursing time,
but that's all. We'd provide the medical consultation, the
dental program (which was rather elaborate), and we would do
the things they couldn't do- -we would provide the technical
leadership for their health program.
That turned out to be wise because if our budget had kept
expanding endlessly, we were going to be the perfect target for
all kinds of interests. Moreover, we would probably not get
the cooperation from the schools if they were faced with using
services directed by outsiders. They were marvelous. We had
no end of cooperation, but we gave them preventive medical,
dental, other kinds of services. If they had health problems,
we'd get there right now to take care of them. And they had
problems a-plenty, so we made lots of supporters for the health
department.
Crawford: How was your budget allocated?
137
Blum: We presented it first to the administrator; then the
administrator worked it over and it was presented to the board
of supervisors. But I personally presented it to the board as
health officer.
Crawford: Generally speaking, what needed to be done?
Blum: Oh, well, everything. We didn't even have a laboratory. When
I took the job, the state health department said, "This is the
worst health department in the state. So take it easy." My
logic was, "No. If we take it easy, that is what we'll have--
the worst health department in the state forevermore . " Then
those things that I just described fortuitously happened. The
Tuberculosis Association offered all their big-wheel support,
and then the PTAs . These are the folks that make up the grand
jury and all the community organizations, and are the voters
who vote.
Then the PTA asked me to make a few talks here and there,
and I did. The next thing you know I had an honorary badge,
and pretty soon the PTA will come and testify about what they
need, and what their kids need. Then you have the health lobby
all built, if you're willing to use it. Most health officers
were not, apparently, afraid that they would have to pay
something back. But PTAs, Leagues of Women Voters, and health
associations don't want things for themselves; they want good
health for everyone, and that is truly easy to live with.
As I indicated, we didn't need everything in our program.
The board tried to give us the dog pound, and we said, "No way.
We're not taking the dog pound." I offered to quit if they
gave us the dog pound. I said, "There are people who can and
have run the dog pound. It's either public works or the
sheriff's department where there are trucks, communications.
That's not a health department job." What was worth our time
was helping the school nurses, and guiding the uses of the huge
amount of money spent on various school budgets. The school
nurse is tremendously important. In those days, they were not
just the doers, they were the teachers, too. They taught the
teachers about health matters, organized the school health
programs. You could get health services and observation in the
schools through the nurses that you couldn't get in any other
way. Some of their nurses were ex-nurses from our service. If
the schools would pay more, our nurses would go there. They
did, and it didn't hurt us as they got employees who knew what
good programs were. It also helped raise the salaries of our
nurses .
138
Signing Off on Septic Problems
Blum: There were many, many interesting problems of many different
sizes. One day early in my career, the district attorney came
in (he was really a character—ultimately became a state
senator) and said, "Here, I want you to sign these papers." I
said, "I don't know what they are." It was to the effect that
I was supposed to vouch for the fact that this, that, and the
other thing is getting done in a subdivision. "I don't even
know where the subdivision is." He said, "Well, that's all
right. Your predecessor never worried about that. He just
signed. Now, here, sign them." Well, I'm not signing a thing
if I don't know what I'm signing.
The district attorney is a powerful man, and so I suggested
that maybe he spend a little time with us, telling us what it
was all about. If we signed, we were testifying that the
subdivision could get rid of sewage, had safe water, and a few
other things. I said, "How do I know what the sewage disposal
is like?" "Well, it's got all septic tanks, and the building
department's inspected it. The building department signed off,
but their signature doesn't count. It has to be the health
officer's." On quizzing our own sanitary inspectors, it was
their impression that the septic tanks wouldn't last more than
a month or two or three, and then the sewage would be out in
the neighborhood. I told him, "If you think I'm going to sign
this, you're crazy."
About ten minutes later, the chairman of the board of
supervisors, who was a nice guy--an electrical contractor named
Jack Cummings-- comes in. He's a great, big, handsome fellow.
He said, "Doc, I hear you won't pass this subdivision. You've
got to sign these. My god," he said, "A couple of us have a
quarter million dollars in it." He said, "That's the kind of
money they owe us for the work we did there." He had nothing
to do with the septic tanks and he was the chairman of the
board of supervisors.
I said, "Well, Mr. Cummings," I got to know him as Jack,
ultimately, "if I sign, there's going to be nothing but
trouble." I said, "We've been thinking about it. If we open
up a couple of septic tanks—we'll let them open them up— and
if they look like they'll work, we'll let the subdivision go.
But I'm never signing another one because I don't think any of
these will work from what I've heard, even though it's been
inspected and cleared by the building department."
139
He said, "Well, what would you have to have?" I said, "We
have to have a new ordinance, we've got to have the manpower to
inspect, and contractors have got to meet certain standards."
They're well-known, basic standards. Everybody else is using
them. In a way, this was blackmail. Another member of the
board was the real estate agent for the subdivision. He was
another nice guy. These were kind of fun people, but this had
been going on forever, and the health officer had been the
stooge who allowed it to happen.
So I passed the word: "I want to see three septic tanks"--
there were probably thirty--"in different places in that
subdivision. Open up any ones you want. If you think there's
a good one out there, we'd be glad to see it."
So they opened up three septic tanks. They were all
disasters, all of them. They were made out of redwood bark,
not wood—they used to get big slabs of bark from big redwood
trees. They were about six feet long and two inches thick, six
or eight inches wide. The builder put one nail in at each end,
put a little tar paper over it--not even wood, you know, just
bark. They had scooped out a hole with a clam shell. Then
they put this box down, brought up some terra cotta piping to
it from the house, and some more from the tank to make up the
drain field, and used a caterpillar to push the dirt back in
around it, and it was done. Our inspectors, who had not had
anything to do with the inspection but who couldn't resist
watching because they knew they would be called in as soon as
the septic tanks failed, said the tanks would almost for sure
be collapsed because the cat had gone over them while pushing
the dirt around, and the pipes were being broken and
disconnected. This "tank" would hold sewage for a week, a
month, two or three months, and then it's over. There's no
septic tank there.
I had told the contractor that I didn't want them to fix
anything, that I wanted to come out and see the tanks as they
were exposed. I get out there, and here's one that has all new
pipes and fresh cement. It was still a disaster, and this guy
said, "Oh, it's them goddamned niggers that work for us. They
just do these things." Really "nice" people. So we suggested
that they dig up a few more and fix them all, and shape them
up. We approved the subdivision on the understanding that the
board was providing a new ordinance, that we doubled our
sanitation crew and started life anew with a suitable permit
and inspection program. Over my desk, for all the years I was
there, was this great big piece of bark that came from one of
those septic tanks. I also learned, though, that when we had
trouble in these situations, I could not take colored pictures
140
with my camera, because even sewage looks good in a colored
picture. So we turned to taking black and white pictures for
evidence. [laughs]
The County Hospital and George Degnan
Blum: The county hospital was totally separate from the health
department. That was run by a master politician and super
surgeon, George Degnan. A tremendous fellow. He was the chief
surgeon, and chief doctor, and chief everything. He was
actually a fabulous surgeon.
Crawford: Talk about him--I believe he was medical director from about
1948 to 1980?
Blum: Oh, he was a handsome, great, big guy--a woman's dream of a
chunk of man. Women were always tagging after him. He was a
star football player here at Cal in his earlier years.
Crawford: He was a local person, wasn't he?
Blum: He grew up in Richmond, I think. He was a fine athlete, and a
marvelous doctor. I was impressed, because at the county
hospital, I undertook to make the rounds on the contagious
disease ward. They didn't have any expert on that and they had
done some stupid things as a result. So I did that because I'd
done a lot of it in San Diego, and I saw a lot of George and
his work as a result.
Crawford: Was that part of your role?
Blum: No, but everybody would be happy if I did become the visiting
M.D. on the infectious disease ward. I had a good time there,
and saw all kinds of interesting cases. We got contagious
disease cases from Solano County, and we saw a fair variety of
contagious diseases. The ward served the contagious disease
needs of the 300,000 persons in the county at that time.
Crawford: Was that where services to the poor were delivered?
Blum: Yes, but everybody with contagious diseases also, because other
hospitals didn't want to fool around with them. They were too
expensive, too tricky, and if the disease spread in the
hospital, it would be a true disaster for them.
141
George was a magnificent character. He was a strong labor
man. He had ties to the unions that even an episode of
scabbing couldn't kill. George actually could tell the board
of supervisors what was going to happen because the unions had
the votes. One supervising district was controlled by farmers,
but unions ran the rest of them. Even though the big oil
companies and the chemical companies had a lot to say, the
truth of the matter was that their unions often had more to
say, since it was their members who voted, and they often
agreed. So it wasn't all that hard to get what they wanted.
George had the union vote. I had the PTA vote, which was
growing more powerful each year as the county became a major
bedroom suburb of the Bay Area.
Crawford: Were you opposed to each other?
Blum: Yes, you see, he would influence the budget one way, and I
would tend to influence it another way. We would draw from the
same basic pool of funds for competing purposes.
Crawford: Oh, his budget was a generalized medical budget?
Blum: His was a big county hospital budget, while ours had little for
medical care as such. They also did the tuberculosis patient
care, and did a terrible job as far as we were concerned. We
finally forced the issue and then he put his chief assistant on
the job--a physician by the name of Louis Girtman--and Louie
was another marvelous person. He came out of the Ozarks, and
he didn't care to work with rich people. He loved poor people.
He could empathize with them. He worked all his life with poor
people—he worked day and night at that county hospital. Louie
took over the TB program and paid attention to what we believed
had to be done, and they started doing a good job.
We were always crossing paths. We had the contagious
disease people in common, and we were responsible for them, but
they took care of them. We were responsible for TB, but they
took care of the TB patients. They were responsible for rehab,
but we ran the crippled children's program. We even built a
rehab unit there at the county hospital. We found money for
this and money for that, and if we could create anything for
the county hospital, it was great by them. We created a
building in Richmond, I got the money for it because of the way
funding was arranged for; the county hospital used most of it.
I was on the governor's hospital council which made all the
decisions on the awards of Hill-Burton Act funding. We created
a building in Pittsburg, and the county hospital used most of
it. It was an odd sort of competition. We wanted the same
things done, but they were usually at a different part of the
142
ball game than we were. So we were always competing, and
George had more influence, so we had to work harder.
Crawford: Where did he get the influence?
Blum: Labor. You see, even the merit board in civil service that
would set salaries was run by labor, and George had the civil
service board at his beck and call, but not the civil service
department employees. We both hated the civil service
department employees. They always kept telling us what we
wanted, and they didn't know anything about health. So we
could sort of commiserate.
But when we'd get there for negotiations, we'd sort of be
pulling apart for other reasons. For instance, he wanted to
pay his nurses more than we wanted to pay ours. Well, ours
were all better trained. Ours all had an extra degree. But
we kept up a fairly friendly exchange. He was at our house for
dinner, and he'd take us out. He was, at that time, a
bachelor; although he shortly had a wife and children. He may
have had another child from a first marriage to a very
prominent San Francisco socialite.
Crawford: I know June Degnan.
Blum: June. That was his first wife. I don't know for sure if they
had children or not, but I knew the second wife. They had a
couple of kids who are now doctors. I never did meet June, but
we saw George a lot of times. We'd go here and there to dinner
together. We really wanted the same things for the same kind
of people. We had the same general approach to life. But he
was a surgeon, and I was a public health officer--! mean, we
were getting to heaven through different worlds.
Crawford: What was the practical basis of the difference?
Blum: The difference wasn't so much about what we wanted, but he
wasn't fussy about how he got things. I was very, very queasy
about getting things in what I saw as underhanded ways.
Crawford: By means of labor tactics?
Blum: Yes, just across the board. I remember one night we were at
our house, and he was saying, "With the politicking you're
doing...." I'd just won something away from him, you see.
"You know, this is terrible," he said, "You go around kissing
babies and all this PTA stuff." [laughs] Well, you just had
to laugh, you know, because that's how he saw it. Here I was
"playing the women's side of the street," and he was playing
1A3
the men's side of the street, all those tough labor guys. Yet
we pretty well pulled together over the years. We got some
really good programs going between us.
Crawford: That's where the first county-run HMO came out of, wasn't it?
Blum: It came out of his bailiwick.
Crawford: Were you involved with that?
Blum: Not really. I'd give it moral support, but it was not ours to
organize. He had dreams that we'd have universal coverage one
of these days, and he wanted to work his people into a system
where it would work that way. When he was allowed to replace
the hospital there, he built a temporary hospital—one that was
only going to last twenty or thirty years—because county
hospitals would be past history, and there would be no more
county hospitals when there would be universal coverage. He
was very alert, and his heart was in the right place, but his
timing, as well as mine and everyone else's, was off by a half-
century or more. There's still no universal coverage in sight.
Crawford: He thought everything would be universal coverage. What was
coverage like back then? I guess we're talking about the early
fifties.
Blum: You got insurance with some jobs, but a lot of people didn't
have that kind of a job. Almost nobody could ever afford their
own private insurance. Nobody had it. Not for health care.
It was a dilemma.
Crawford: Was that at all unethical to build a hospital for twenty years,
with built-in obsolescence?
Blum: Oh, no. It was wise. Everybody else was building monuments,
and here's George saying, "Okay, we don't need a monument. It
will be gone. We won't need it." This is the head of the
county hospital saying we don't want a county hospital.
Crawford: Did the two of you reinforce each other in the community?
Blum: In a sense, yes. Yes. I mean, we were constantly friendly
enemies or friendly competitors, or something. I remember when
the Easter Seal Society came around and wanted us to do
something. They were going to put on a big campaign, and the
campaign was to state that our county health department had the
best crippled children's service in the state. Well, it
probably did, but that's nothing to put into a campaign which
is going to tell my board that their health department is the
Crawford;
Blum:
Crawford:
Blum:
best in the world therefore it won't deserve any significant
new funding. I mean, one just can't say stupid things like
that.
George was at the meeting. It was in my office, I
remember, he was this big handsome guy, and he was listening to
these ladies who were driving me nuts. They just could not be
talked out of it. I said, "Look here, it's our county, and
you're coming from San Francisco and are telling me how to play
ball here. We'll get you whatever you want, because we want
the same things, but don't come out with this kind of
propaganda, like it's the best program in the world. It's
insane." They just couldn't hear me. So I got up and walked
out, slammed my own door, and left. George, they tell me
afterwards, turned to look at these people — and he hadn't said
a thing all this time — and he said, "Well, I think that settles
that, doesn't it, ladies?" He was a good ball player, a good
card player, a good poker player, and it worked. They came
around and did what we wanted. It all worked out very well our
way without our telling the world we had the best health
department. If you do something like that, you're crazy.
We worked together all the time. We got in the mental
health program. We got a huge program.
You got a huge one for his hospital?
Well, for the county. It included the hospital's needs. But
the only way we were going to get it decently done was to let
him run it. So we did.
Was it a good mental health program?
It was super, the only one of its kind. In its day, it was a
very fascinating thing. We hired psychiatrists to come in and
work with human service departments once a week— so much time
spent with department heads, then some more time with people in
charge of the mental health aspects of their programs. The
partners included the school districts, junior college,
hospital, health department, police departments, sheriff's
department, probation, and welfare. We even taught cops how to
bring deranged and violent persons into custody without having
to knock their brains out. "You don't have to subdue violent
people with violence. There are many ways of doing this, even
if persons are violent when you come to get them." We did all
sorts of things—advised judges. It was a tremendous mental
health program. It was a kind of "trickle-down" business.
145
Crawford:
Blum:
Crawford:
Blum:
There were no psychiatrists in Contra Costa County when I
came there, and by means of this program we got outstanding
psychiatrists to give the key departments a way to proceed.
The next thing you know, every department had a mental health
trained person as each hired folks that had Ph.D.'s or M.D.'s
or some degree in mental health, and they advised the various
human service workers, teachers, police how to better deal with
mental illness or emotional problems in their own department.
George finally got some psychiatrists at the county hospital.
All of a sudden, we had a program that really trickled down all
the way to the thousands of people who needed help.
The next thing you know, Contra Costa was a bonanza for
psychiatrists. I never was sure we did the right thing,
because everybody who could not be cared for by our
intermediate-level workers was being referred to psychiatrists.
But the county's program was relatively low-cost. Of course,
we still had to hospitalize the serious mental health cases in
the county hospital. That was George's real leg to stand on,
and they indeed had a very interesting service there. They did
all kinds of good things. Well, the overall program went to
George for administration, and nobody fought it. We had all
fought together to get him the money so he could do it. The
same psychiatrist who headed it up in the fifties is still
there .
The county hospital was in Martinez?
In Martinez. It's still there. Now it's being rebuilt. The
old monster had to be torn down. The new one's going up. It's
a highrise, and there's a great question whether it's needed
now. That wasn't his fault.
The community wanted that?
Well, it was a huge battle because organized medicine and the
other hospitals didn't want it to be rebuilt. The county
pointed out that it had to take care of the people the other
hospitals didn't want. "Oh, we'll take them, we'll take them,"
was their response. But before it was all through, they didn't
want the criminals, they didn't want contagious disease, and
they didn't want this, and they didn't want that.
So all the tough cases were going to be left for the county
hospital. That means the county hospital had to have a
pharmacy and surgery and x-ray and all those social services.
So the county still had to create all the expensive parts of
the hospital, for just a few special and very expensive kinds
of clients.
146
Crawford: Did he want them to be treated in their own communities?
Blum: Oh, George was gone already. George had retired, but he
continued to fight against the new hospital. He thought it
ought to be disposed of, once and for all. That's what he died
over, supposedly. He was in his eighties, still fighting.
Didn't think a new hospital should be built just for the poor
and a few special categories of patients, that the poor could
just as well be served where everybody else went. But the
private facilities wouldn't play ball as late as 1995, and the
board of supervisors had no choice since they have the legal
responsibility to cover those with no other source of care-
best known as the county "safety net".
Crawford: So that must have been a major frustration for Degnan?
Blum: Yes, his big dream--and mine too—that we wouldn't need things
like county hospitals. Who the hell needs them, really? Just
another set of facilities for everyone to pay for.
Crawford: It's discrimination.
Blum: Of course it is, and a terrible waste of money, full in hard
times, empty in good times, just the reverse of the other
hospitals .
Crawford: What other major problems did you confront initially?
Sanitation Problems and County Restaurants
Blum: Well, on the other side — the sanitation side — there were other
messes like those with the septic tanks. Food sanitation was a
terrible thing.
Crawford: You touched on that; said you closed down scores of places.
You weren't very popular.
Blum: Oh, hundreds, literally hundreds. I remember going as one of
the honored guests to the annual banquet of the food
distributors in Jack London Square. All the health officers in
the East Bay were invited, and there were quite a few of them
at that time. I remember that they had this lady from Broadway
and Columbus—Carol Doda. With the tremendous superstructure.
She was the entertainment and she was going to introduce us.
[ laughter]
147
Oh, well, this is not a highly cultured crowd—the food
distributors, liquor distributors, and tobacco distributors.
But these are all the real folks that count. When they
introduced us, and my name came up, you never heard such a
booing in all your life. [laughter] I thought, "Boy, I'm not
even safe here."
Crawford: Well, what did you expect?
Blum: Well, I thought they'd be civil. [laughter] So, then, we had
Carol Doda, and they didn't treat her like that. She danced on
the table tops. So that was my standing. It was pretty good,
in one sense. At least they knew we were there. We had closed
hundreds of unsafe places.
Crawford: What did you find?
Blum: Filthy operations.
Crawford: No health standards whatsoever?
Blum: No, yet we had inspectors — college trained, most of them— but
business is business, and if the boss doesn't insist on it, the
inspectors go along with the operators. For instance, San
Francisco was a scandal. Its food places always were.
Crawford: And it is still?
Blum: Of course. I'll never forget, I took somebody out to dinner at
a fancy place down on Maiden Lane with a French name. It used
to be out on Geary Street.
Crawford: Is that the Fleur de Lys?
Blum: No, no. Not that one. This is another one. Any event, it was
very ritzy and expensive, and here comes the butter dish, and
out from behind the butter cubes comes the biggest cockroaches
you've ever seen. [laughter] Things to admire, like in the
tropics. And these were just little old cockroaches grown to
giant size!
Well, San Francisco always had filthy food handling places.
I remember I used to eat in the New Pisa. One night my wife
was in the city. I was coming from the airport, and we invited
one of my assistant health officers to dinner there in the New
Pisa. He'd never been there. We met there, and they had very
good food. I mean, they really had good food. They knew how
to make raviolis. You can't get them like that anymore. Well,
he was in the men's room to wash his hands, and he comes back
148
and he says, "Say, Boss, would a place like this be allowed to
be open in Contra Costa County?" I said, "No, not by any
stretch of the imagination." [laughter] That was not the
worst in San Francisco, but their men's room was something else
again, and their ladies' room wasn't any better. The new New
Pisa is okay.
Contra Costa had been like that. I had a dear auntie who
came out to spend a few weeks with us in the fifties, and 1
asked the inspectors, "Where's a good place to take my aunt?"
I knew the San Francisco restaurants, but then you have to go
back and forth to the city. They said, "Well, to tell you the
truth, there's only two clean ones. There's a third one,
sometimes." This is in all of Contra Costa County. I said,
"You've got to be kidding." They said, "No, no. Cape Cod
House—that ' s good. That's how a restaurant ought to be run."
Then there's this little place I'd never heard of--this Italian
place — in Pittsburg. They said that was a really nice and
clean place. So I decided to start visiting restaurants myself
at night, after work. I'd start out sometime around four or
so, and inspect half a dozen, even a dozen places in an
evening.
it
Blum: Once at a San Pablo restaurant early in my career as a health
officer, another aspect of law enforcement came to my attention
rather abruptly. A Chinese inspector, one of two Asians in a
team of fifteen, called to say that an irate cafe operator had
driven him out, saying that "no Chink was going to tell him
what to do." What should we do next, the inspector wanted to
know.
This seemed like a good educational opportunity, so I asked
him to get me the phone number of the cafe. I made a call to
the operator, telling him who I was, and that we had no
intention of making him accept any one inspector, and that I
would be happy to inspect his place myself the very next
morning.
This would give him time to clean up, but the place was so
bad that it probably wouldn't look a lot different the next
day. I came in quite cordially, repeated my friendly offer of
doing the inspection myself, took out the rating sheet that we
always used, and went to work. I interpreted the ratings quite
literally, and the operator got sicker and sicker, assured me
that he loved Joe, couldn't Joe come back and they would get
the corrections done in jig time.
149
Joe told me that he never had a more cooperative operator,
and that they got along fine after that.
I guess the method was not to back down if we were right,
but to try another tack and not attack frontally, such as
shutting the place down, which we had the authority to do.
The matter of law enforcement remained a fascinating area--
a kind of battleground between ethics and the presumably
justified exercise of power. One incident that I find hard to
forget is St. Mary's College in Moraga. Their students and the
faculty ate their meals there. As part of our routine
inspections, we gave them a Catholic inspector who had a hard
time educating them up to standards. The food service was
leased out to a major so-called first-class operator, but the
plant itself was decaying and impossible to maintain. It
finally got too bad and we gave them a notice of forthcoming
closure if repairs weren't underway in two weeks.
The senior Brother Albert in charge (there were two
Brothers Albert, and the senior one seemed to fancy himself as
a direct emissary of God) called me to tell me that he was
going to have ray job, four county supervisors being Catholic,
the fifth in a Catholic district, and the county manager was
also a Catholic.
I didn't object to his approach but explained that there
would be an official closure (if there wasn't compliance) and
that anyone violating the closure would be served with a
warrant for arrest. At this point some 200-plus students came
down with food poisoning and we closed the food facility on the
spot, a week or so ahead of the threatened date.
I never did know if Brother Albert also got the crud as
extra punishment. I suspect not, because he went skiing at
this point, and on the way home drove into a tree and killed
himself. I always hoped that we were not a contributing
factor, rather that the Good Lord's way simply took place,
solving all Brother Albert's problems and one of mine.
II
Blum: There were many kinds of things in the sanitation field. I
mentioned that I had a wonderful sanitarian who was born and
raised in the Ozarks, who'd gotten his training during the war
in the navy. Bill Martin. I don't know if he's alive now, or
not. He became the head of the sanitation program in another
county when he retired from Contra Costa. He could see the
unfairness of a lot of these things. It bothered him. He was
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just an unsophisticated person who hadn't been educated to
overlook the real problems. He had enough education to carry
out the law and do it well, and as I told you, we were fairly
tough about enforcing the food laws.
Crawford: That's what you said. You got booed at the annual banquet.
Blum: Yes, well. I don't know if I told you about this or not, but
Bill led me out to a little place that he was going to clean up
in north Richmond- -a black community --where one way or another
you'd say, just as you did in any other community, "Do this, do
that, and if you don't do it in so many days or weeks, we'll
close your store." That's it—very simple, very fast, very
direct, very legal. Well, he said, "Boss, I want you to see
this — see how you feel about it." Having presided at the
closure of a Safeway and a lot of other stores, he had a good
idea of what we did for businesses that wouldn't stay clean.
Here was a little old shack; it was kind of cute. It had
all new roofing on the outside- -the fireproof kind. You
couldn't really complain, you just weren't used to seeing
roofing on the wall. I got inside, and here was a brand new
floor—a maple floor— and it had funny little white bands here
and there. I asked what kind of floor it was, and he said,
"It's an old basketball court I found." Those were the little
white marks. [laughter] Well, they put it all in just so, and
then the shelves were all painted white. There was a little
stack of groceries on this shelf, and a little stack on that
one.
The owners couldn't afford anything. It was a little
neighborhood store, and it probably fed them at wholesale
prices, but they were there, serving their immediate community.
Then he had a stainless steel sink, and I said, "Bill, how did
you ever get that?" He said, [drops his voice, so is almost
inaudible] "I saw it out in a wrecking yard and they got it for
a couple of bucks." He said, "How do you feel about all of
these changes?" I said, "Wonderful. It's fabulous." He said,
"Well, that's what I was thinking. They couldn't do this by
themselves, but with a little help, they could. Otherwise,
we'd close them and send customers to Safeway up the street."
That was Bill's way of doing the job without following the
steps laid out in the food ordinance. He got them to achieve
the sanitary results called for in the law. In other words, he
was coming out with the results that the law intended.
Crawford: He didn't like to see them closed up?
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Blum: He didn't like to see people hurt. His education hadn't
overcome his good sense. He did many such things. He cleaned
up the city of San Pablo. We knew it was a death trap in many
places. There were rubbish piles, rodents, big piles of
lumber. Many of the people who came in for the war effort
could barely afford a packing box for a house.
Crawford: San Pablo was worse than Richmond?
Blum: Oh, yes. Richmond had pretty good standards. Richmond had
poor people, but everything was done according to the book.
There was a health officer there—an independent one — and
ultimately we absorbed that department. He was good. He got
good support. It was a strong labor town, so there wasn't too
much trouble targeting for reasonably safe housing and streets,
public services.
San Pablo was a whole other story; that was the home of
gambling and prostitution; it was a rough little neighborhood.
The mayor of San Pablo owned a restaurant, and it was filthy,
vile. I remember going down there because we were going to
close him. He wouldn't correct it. There were mouse droppings
all over everything. He was a belligerent gorilla, and I said
to him, "Look, here's mouse droppings. What the hell more do
you want?" He said, "Prove to me that they cause illness." I
said, "I don't have to prove a goddamned thing to you, mouse
droppings aren't tolerable."
Well, he didn't take us to court, but he might have. He
was that kind of a guy. He was also president of the hospital
district-- just everything. He was a real political animal. To
clean up San Pablo, you weren't going to get much support from
people like that, at that point. Well, we simply used our
basic authority, since I was the health officer for the city,
too.
Blum: One last episode about food sanitation. There was a two-story
Safeway in El Cerrito that had a bad manager. Although we had
closed a store from every other food chain at one time or
another, Safeway was well above the average and fixed any
violations as soon as we spotted them. This store ended up
with a burst sewer on the lower floor, and people were getting
their milk, vegetables, meat sloshing through this mess. The
inspector gave them a day or two to get it repaired, came back
and found it worse, if anything. He called me down--I couldn't
believe my eyes--I would have given them two hours.
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We found the manager and told him that he could put a
closed sign on the door, and keep it closed until we let it
open. If he didn't wish to do that, I would put up our sign,
"Closed by order of the Health Officer." He squalled around
and when I started to put up our sign and warned him that I
would stand by and have him arrested if anyone were allowed in,
he decided to be "closed for repairs."
I got back to my office to an earful of protests. The CEO
of Safeway, who lived a few houses from me, called to demand
the store be reopened. And since that wasn't going to happen,
would I hold the closure in abeyance until his chief lawyer got
back from England where they were just opening up Safeway.
This closure was a new experience for them and they were
mortified and furious.
When it settled down that we meant business, they offered
to sue and I told them that that was their prerogative under
the law, and we wouldn't object, but we did have a lot of
photographs of what was wrong, and that they might not like the
protracted debate that would result.
This resulted in a date for a luncheon the next day at the
Safeway headquarters in Oakland, where I met my neighbor for
the first time. We had a lovely lunch, they got the picture,
and shortly thereafter they were back in business in an
exemplary way.
This event became well known for no one had ever dared
close a Safeway. Some thirty years later, I was consulting for
the Contra Costa Health Department on a rather tricky issue
which involved about thirty prominent citizens. As the meeting
got underway and I was introduced by the chair, who was
currently involved in the new Orinda Vision Study from UCB and
was most flattering. A husky female voice followed on in the
pause in a well heard aside, "He's the guy who closed a
Safeway." That was apparently a critical accolade regarding my
credentials.
1 should conclude the food sanitation concerns with a truly
heartening tale. One stormy wintry night I was in bed in our
Walnut Creek home with a good achy, fevered, old-fashioned flu.
The doorbell rang at about eight-thirty coincident with some
lightning and my wife peered out to see two huge men at the
door. She cracked an adjacent window and asked what they
wanted. They announced that they were the Burroughs brothers
and had to talk to the health officer. She explained that I
was ill and surely contagious as well, but that didn't bother
153
them. She cleared with me, brought two chairs into our
bedroom, and led them in.
I knew of these men because they ran the largest milking
herd in California still in private hands, over 1,000 cows.
They were located in the far eastern end of the county along
the Sacramento River and sold their milk under the Cloverdale
brand.
Their problem was an odd one. Their longtime herd master
had left a few years before and had just returned. He reported
that there were a lot of cows with bloody urine, that there had
been a drop in milk production and a rise in abortions. These
were ominous findings. He had verified that there was no
brucellosis and suspected some new-fangled disease whose name
the brothers couldn't remember. Moreover, one of their
milkhouse men had just died in the county hospital on the
contagious disease ward, cause unknown. Their question: should
they shut down the dairy that night and start dumping the milk
until the problems were clarified, and any suspicion of milk-
borne disease laid to rest?
It so happened that I was in bed studying the latest on
leptospirosis , a kind of new infectious threat to cattle that
waded around in the heavily irrigated lush river valley
pastures. I had also taken care of the man who had died on the
isolation ward and had sent specimens to Holland for
confirmation of our suspicions of leptospirosis, all of which
were negative and his cause of death remained unknown.
This was a predicament. The herd probably had
leptospirosis, but my books didn't say whether it was spread to
humans by cow's milk, nor whether it was clearly prevented by
pasteurization of milk. This was now about nine o'clock, the
men were overwhelmed that I was studying their problem, but I
didn't have a secure answer to what could well be their
voluntary bankruptcy if they shut down. The one world's
authority available was K. F. Meyer, a Swiss veterinarian with
an honorary M.D. who was head of the UCSF Hooper Foundation, a
revered and world-famous scientist who had been one of Bill
Reeves 's major mentors. I got him on the phone and in his
inimitable style he said, "You haf no problem, pasteurization
will keep the milk pure, let the dairy continue to operate."
K. F. was a fearless man, the most knowledgeable person in the
world on dozens of diseases, and perfectly happy to take the
responsibility. The Burroughs brothers were obviously happy
and then wanted to know when we could get going on their cattle
disease problem. Since we had K. F.'s ear there was no doubt
that we could get into it even though we had no lab of our own
15A
at that time. As an aside, oil and gas were shortly found on
the Burroughs property, and I can't think of nicer people to
whom that could have happened.
K. F. Meyer helped me organize a meeting at the veterinary
school at UC Davis and we had the State Departments of Health
and Agriculture and the federal USPHS and Department of
Agriculture. I presented the problem, twenty or thirty
employees and family members whom I would bleed and test, and
who would do the 1,000 cows? Nobody would, it seemed. Yet
this was a critical new problem in California. I got disgusted
and said that we would do it. A big bluff because we didn't
even have a laboratory, let alone a fancy one to do relatively
new and complex testing. That was too insulting for the high-
level agencies to hear and resulted in a bidding war between1
them until all parts of the job were assigned and all I had
left to do was drawing the blood of the people at the dairy.
This problem was found to be a huge one for the cattle industry
on wet pastures, but not a human problem.
II
Blum: We had been very active in setting up a poverty program to give
folks a job doing useful labor, and Bill Martin got twenty or
thirty of those people to work for the health department. He
sat down with them and showed them how to fill out an
inspection form as they were close to being illiterate. He
took them to different lots, and told them what was wrong;
showed them what to check on the form. He had a good touch
with them; he was from Missouri or Arkansas, and these people
were his kind of people from way back.
He taught them how to do the inspections. We inspected
every house in San Pablo, found all sorts of messes; everything
was written down and all of them were cleaned up — first time in
history. Nobody believed it. We had hearings for the two
people that held out—that didn't get their place cleaned up as
scheduled. I sat there at my big desk, and Bill ushered the
first one in. It was a lady- -very heavy and probably twenty,
twenty-five, just had a baby. In the course of that she had
dislocated an intervertebral disc and she had terrible sciatica
pains. She came in with tears in her eyes --wouldn't we give
her time to recover so that she could clean her place up? I
said, "Well, sure," and gave her all the time she wanted. Bill
found her some help.
The next one was a man who had rheumatoid arthritis so
badly he was scissor-gaited. I mean, his legs were actually
crossing one in front of the other. His hips were gone; and he
wasn't that old a man, but he was thin as a rail. He was a
155
critically ill man. He too asked for a few more weeks to clean
up his yard. Well, as you think back on it, if it hadn't been
for the poverty workers and Bill, we probably would have been
shot as we attempted to enter these places; but here were
inspectors, our poverty people, coming in to see people who
were very much their own kind. They weren't all that hot on
reading and writing; they weren't college-degreed inspectors,
but they were pleasant, and they could recognize folks and
their homes — their kind of poverty, their own problems, and
help them solve their sanitation problems.
Crawford: Did you get OEO [Office of Economic Opportunity] money for that
project?
Blum: Yes. As the health department, we were the main figure in
writing up the OEO proposal for Contra Costa County. We spent
weeks on it and got a huge grant but, interestingly enough, I
went to Washington with it, and Washington dismantled the whole
thing. They said, "You're not doing it right." Well, we had
put together monies for the several ghettos--we had Pittsburg,
Richmond, and San Pablo, poverty areas in particular — and we
wanted money to go to the schools, to public works, and to
welfare, and for some health things, and we wanted it all to go
to the same communities in order to create a significant
simultaneous effort. Washington said we can't do that; we'll
put the school money in this place, and we'll put the welfare
money over in that place, and the health money over in that.
We'll divvy up the money, so all the communities will be
satisfied.
So, we never had enough to work with in any one place that
could train for jobs, put the trainees in a job, get their kids
into beefed-up schools — feel the full effect.
Crawford: Just fragmenting everything?
Blum: Just stupid, but supposedly good for votes. I went to
Washington over this, and I sat with a bunch of hot shots. I
• took what we used to call the red-eye special. I remember
coming in there, dopey and sleepy, to this big meeting. I was
the only health officer there from the United States, and I
told them that we were just tired of disintegrating. We wanted
to take the kids, the parents, and the housing and get it all
together and fix the bad neighborhoods, get folks going. But
doing it their way when the poverty administrators got through
spending the money there would be a little more for schooling
in one place, the housing would be somewhere else, and the
parents who would get jobs were from somewhere else. I thought
156
this was insane. Well, I was the insane person, and that's the
way it was.
Crawford: They didn't accept your ideas?
Blum: No, politics is politics. They were doling out money. They
wanted to spread it as thinly as possible. They didn't say
that. They said widely, but it was thinly. In any case, we
got a big chunk of poverty workers, and Bill used them as I
described, and got a job done that you couldn't have done with
trained inspectors. Nobody would have understood who was
talking to whom nor why. Here's what a good human being can
do--really pretty remarkable.
Crawford: So that's a major accomplishment.
Blum: Yes, but it was just one man's dream that you could do these
things if you dealt with people like people.
Labor and Industry Politics: Tidewater Oil
Blum: The bald realities of crummy politics were charmingly presented
by some of the less usual but not rare occurrences. One was
created by Tidewater Oil, also known as Associated and now a
part of Tosco. In anticipation of selling out it was
neglecting its still-operating old plant just to the east of
Martinez. One day we got a call from a group of Port Chicago
householders just downwind of Tidewater, that several horses,
sheep, and goats had just died and that paint was pitting on
cars that had been left parked outside.
Inspectors took hold, verified the report, and gathered a
lot of plant material on which the animals had been feeding for
analysis. It should be noted that herbivores would perish
first as their diet was principally the vegetation on which
toxics had settled out. By this time we had an excellent lab
and soon determined that contrary to our expectations of acidic
sulfur compounds, the culprit was arsenic. Fortunately, our
industrial engineer had a hobby of keeping track of who bought
arsenic and other dangerous chemicals in large quantities.
Tidewater used arsenic as a catalyst in its cracker. However,
the catalyst supposedly remains, but Tidewater obviously was
losing it and thus using large amounts, a pretty callous
performance. We also had a wind recorder in operation nearby
that showed day after day prevailing winds from the plant
directly targeting the homes affected.
157
Interestingly enough, the Monsanto plant adjacent had a
sulfuric acid pipe failure at the same time. They had a
somewhat different outlook on how to live with their neighbors
and had already sent their insurance people out to obtain and
pay claims for damages they mistakenly thought were due to
their breakdown. All this was very confusing for the
householders and we called a town meeting for the next evening.
I presided, giving out what we knew for sure, including the
wind data, which was pretty irrefutable. Monsanto turned out
as the good guys, but Tidewater showed up in force and made it
clear that the health officer was an illiterate M.D. and
refused to take any further part in discussions or
clarifications about what had to happen.
That did annoy me, an erstwhile chemist, to hear them make
up arrant nonsense, as well as denounce the health department.
So I put a letter on the board of supervisors' desk first thing
next morning, asking for a public hearing on Tidewater's
negligence, threat to health, and dishonesty. Anything on the
board's blotter is public business and they had no escape
because my written request for a hearing was a prompt media
event. The board set a hearing for a couple days hence. That
night I got a call from the president of the Chemical and Oil
Workers Union, a so-called liberal union, asking me to back off
because this might hurt Tidewater and thus his union members
who worked there. I countered, asking if his members might not
be hurt if we backed off, since some of them lived exactly in
the area affected.
However, the union head, who was at that very time chairman
of the Civil Service Commission, told me that he was sorry that
I was unaware that our department had several matters of salary
rectification coming up before the commission at their very
next meeting and that it would be unfortunate if our employees
didn't get what they deserved. Apparently, his union was only
modestly if at all interested in the fair treatment of working
people other than their own. In any case, I made it clear that
there was no turning back, and that we had all the evidence
lined up for the hearing.
When the hearing opened, I presented the situation to a
sizeable crowd. The first witnesses to be called were the
union's representatives who in an embarrassingly stupid way
denied any possibility that Tidewater could be at fault. The
second witness was the Tidewater P.R. man, a harmless guy, who
made two points clear. The first was that it couldn't possibly
be Tidewater's doing, and the second was that Tidewater had
found the problem, that it had been fixed, and that they would
make sure it never happened again.
158
I don't believe that our employees were ultimately
penalized for having a politically inept boss.
Growing Wild in Contra Costa; More about Sewers and Other
Amenities
[Interview 4: March 21, 1997] ti
Crawford: When we started talking about your work as health officer you
said, "Contra Costa County was just one ethical issue after
another. "
Blum: All health departments face one ethical dilemma after another.
Contra Costa was no exception.
The sanitation situations taught me a lot about practical
ethics, but primarily in retrospect. That is an interesting
sphere. Most of what you do in sanitation is to carry out
state laws: the health and safety code has hundreds and
hundreds of pages of what you're supposed to do. Of course,
you don't have the personnel or payroll to do these things, but
you do whatever you're forced to do whenever the situation's a
bad one. So you do something. In some health departments, if
the situation is bad, the practice is to look for another page,
and to stay away from this portion of the health and safety
code .
Contra Costa went from probably 120,000 people before the
war to over 300,000 by 1950. It was a wild growth scene. When
I got there in 1950, the population was made up mostly of young
families—the new population. People were moving out there to
a bedroom community. There was a fair bit of commuting back to
jobs in San Francisco and the East Bay, and a fair number of
new jobs were being created out there.
One of the things that didn't strike me until later--!
don't know whether it's an ethical issue or not, but- -we
typically forced the farmers to give up their land by allowing
subdivisions. Then the farmers couldn't resist the new land
values. In turn, their property taxes went up and farmers
couldn't face them. So high land taxes and higher land values
forced or encouraged more and more farmers to sell for
development. So, when there is rampant subdividing, you
automatically flooded the soils with gardening irrigation and
all the waste from septic tanks, because there weren't sewers
in this backwoods country.
159
Crawford: It was done so quickly?
Blum: Yes. You couldn't get sewers in to begin with. You have to
have somebody to vote for the sewers. You have to have
sufficient value to the property. You can't sell bonds unless
you've got something of value. So first the community builds
to get the bond value, and then it sells bonds, and then you
put in the sewers after you've already built the roads and the
houses and septic tanks. The whole process is all backwards,
but there's a reason for it. If you drove to Oceanside in
years gone by, you saw streets all laid out, with lampposts,
and the sewers all in- -but no houses. That went on for thirty
years. Somewhere in the late twenties, somebody decided to do
it right, and they put in all the infrastructure, but then
there was the Depression, and nobody could build. So here were
these tremendous numbers of improvements at great cost, but no
people to help defray those costs.
Crawford: So that you jumped into the middle of an expanding situation.
Blum: When an area first develops out of a rural setting, there is a
near inevitable progression. People buy a piece of land and
expect and want to build on it. There are no sewers to connect
to so they seek a building permit which requires a
"satisfactory" scheme of disposing of liquid wastes and sewage.
The first step is to get soil absorption or percolation tests,
a rough scheme to tell if water from a septic tank can be
distributed over the part of the land not to be built upon, and
kept from surfacing by means of underground drain lines of
specified length.
The tests are done after the rainy season is past so that
the soil will take more moisture. If the results are favorable
and if an appropriate septic tank and drain fields are
designed, a permit is given.
Some soils are marginal, some are a bit marshy if there has
been a good wet season. But what is worse, as lawns and
gardens get planted, they are irrigated and much of a lot can
be saturated that way. All adjacent lots have the same fate
and the whole area can become waterlogged.
Then, toilets won't flush, the drain fields overflow, and
people live in a daily nightmare of sewage, sometimes for
months on end or permanently. You just can't appreciate the
misery of a family in a new home that becomes almost unlivable.
And most people are from a city home where such problems never
existed for more than a few hours and are corrected promptly.
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Such a neighborhood comes to a rebellious state of affairs
and the health department preaches, "Let us bring in sewers."
But sewers need treatment plants and an ultimate discharge
point for the treated sewage, i.e., a bay, a river, sometimes a
lake in a pinch. The costs are huge. A majority of the
property owners have to vote in favor of the proposal and
accept the taxes that go to pay off the long-term tax-exempt
bonds that are used for financing. If there aren't enough
property owners, the costs to an individual householder are too
high.
Large developers tend to do all this in advance, but not
all neighborhoods lend themselves to large developments.
Contra Costa had hundreds of septic tanks, and at some point
the misery boils over and there comes a sorting out among
property owners. If not enough of them join, there won't be
enough property to justify the bonds needed for the sewage
disposal machinery and pipelines.
Today when cities and counties have matured, they demand in
advance that subdivisions provide not only streets but all the
utilities as part of their package. Even parks, space for
public buildings, and schools are typically part of the
package.
Should I have made a career of fighting for such more
mature ways of doing development? I didn't, never saw it in
that light. Would I have accomplished anything in the sense of
getting a more reasonable set of outcomes earlier, or did our
approach of fixing bad situations lead to the better current
practices anyway?
Typically, the sanitary districts that would have to
provide these services would either run an election and see who
voted against it, or they would go from door to door in advance
and find out who was going to be against it. Then they drew
new district boundaries which left out people who were against
it up to the point where the majority left in the district
would vote for it. The word gerrymander really came into its
own. You might have a cherry stem- -meaning that up to a point,
all landowners want it, and from here on there's a mile along a
road where nobody wants it. So the district boundaries run
down the road. When the district comes to another batch of
property owners who want the district's services, the
boundaries extend once more and take them in. The district is
cherry-stemmed and gerrymandered by this maneuver.
Crawford: The supervisors were doing that?
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Blum: Not the county board but the sanitary district boards.
Crawford: Somebody must have been making a tremendous amount of money.
Blum: Yes, developers and labor and all the businesses that sold to
them, but that isn't really the issue. After a certain point
when septic tanks can no longer be tolerated, you have to build
sewers. By then there are a whole bunch of vested interests
who are now living there. Once an area starts developing, the
health officer is key in signing all the papers and agreeing
that yes, new developments are safe and sanitary when they have
safe water and safe sewage disposal. The value of the land
adjacent also goes up so the farmers can't afford to stay there
as farmers, and they too will vote for new utilities.
Crawford: Were you pressured to do this?
Blum: No, not pressured in a direct sense, but indirectly, yes,
because you have no choice. If people are flooded with sewage,
the health department has to press for sewers, because this is
a dangerous situation for all people in the area and a truly
miserable one for people who can't use their plumbing.
Crawford: Did you eventually get the situation turned around?
Blum: Yes, you eventually always end up getting the sewers.
Crawford: What happened in that subdivision?
Blum: Oh, that one with the ersatz septic tanks? The sewers came in
ultimately, there was a sanitary district to accept this
sewage.
Crawford: It wasn't a disaster?
Blum: It wasn't a total disaster, but it cost householders extra
money. You build a septic tank--junk--and then you have to
throw it away. And you also have to cut up the streets to put
in sewers later on, and pay for their repair, but there are no
options. Practically no options.
The Orinda community was very hard to sewer--big lots, very
expensive. The Contra Costa Central Sanitary District runs a
sewer line from Orinda out to Martinez to the waterfront where
their plant is. That cost a fortune. They couldn't sell bonds
on empty land. So it was developed- -a little piece here, a
little piece there—then finally it's developed and produces a
mess of sewage. Then the health department says, "Well, folks.
You've got to get sewers." Some of the devices that are used
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are that the health department doesn't permit new schools, or
further new construction. Well, everybody that's involved in
this place suddenly decides that they've got to have sewers.
Crawford: And this is your decision as health officer?
Blum: In a sense, the health officer's always pushing it. All of a
sudden, you realize that you're the king of the developers
without meaning to have anything to do with it. In fact,
you're forcing it.
Crawford: You must have had feelings about that?
Blum: You finally do. But it was many years before I saw that I was
the key facilitator of this badly functioning scheme for
development. As I look back, I don't know whether you'd say
it's ethical or unethical. The crux of the matter is that our
society has no method of doing development sensibly.
Crawford: So, in balance, how did you feel about your dealings with this
issue?
Blum: One always ended up saying, "There's no choice." It's
happening, and so we have to improve the situation.
Central Sanitary District started out with an eight-inch
line from Orinda to Martinez, but within a couple of years, an
eight-inch line wasn't adequate. Then you need a two-foot
line. So you tear up the whole highway again- -and the
taxpayers are paying for this. Then people are able to build
further up the hillsides because of the bigger sewer, and in a
decade you may need a six-foot line.
Highway 24 was torn up all the years I lived there. First
you had a little sewer, then you had a bigger one. Then EBMUD
needed a larger water line, and then BART came in, and that
tore it up again for a couple more years. People never had a
decent road. Highway 24 was a disaster, always and forever;
and always because there's no way of building what is
ultimately needed to begin with. You can't put up the money in
advance when nobody will float those bonds, and if there isn't
anybody to use the facilities, you really are speculating.
Well, there are very few places in the world that can handle
that sort of thing.
Crawford: Who handles it best?
Blum: Well, as you can imagine, Sweden. In Stockholm, the city went
out and simply acquired all the peripheral land, and then said,
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"This is how it will be developed. When we decide it will be
developed, we'll put in transport, we'll put in water and
utilities and sewers." But even in Sweden, this didn't always
work well because of political decisions. It's been kind of
shaky and not every city in Sweden did it. Britain tried to do
it, but could not control planned development well because the
games that are to be played with real estate are monstrous.
Millionaires, billionaires are made out of these things.
It was kind of interesting. Over in the west side of
Contra Costa County, there were a lot of bad areas with homes
on septic tanks that we had approved. The net result was that
there were great slippages; houses slipped after a big rain.
In west Contra Costa the El Sobrante area was swimming in
sewage. It was horrible. All of a sudden, we had a few cases
of little children with dysentery. You wonder, but you can't
prove it is the sewage, but it's very suspicious. Of course,
sewage carried polio, hepatitis, and other infections.
I remember we had a sewer bond election- -which is the
prelude to getting the sewer--and it turned out that everybody
in the El Sobrante area would be against it. I discovered who
the key figures were, and phoned from my desk in Martinez to a
man who was the president of the overall association of all the
El Sobrante community organizations. There were twenty-three
of them. He was also the president of three or four of the
twenty-three organizations. He was an upholsterer.
I got him on the phone, told him who I was, and said, "You
know, you've got a big problem there. I gather you're leading
the movement to fight the sewers. I think you're making a big
mistake because, in the first place, you can't build a new
school there. We're not going to sign for it because it's
going to be swimming in sewage. There's no way of getting rid
of the sewage properly, and we won't permit any new
construction. El Sobrante' s a growing area, and we simply
won't sign off on new construction because you're swimming in
sewage . So let me come down and draw you some pictures . "
His response was very typical, as it turns out. He said,
"Well, now, Doctor, I'll come up and see you in Martinez." I
said, "Oh, no, no. There's no reason for that. This is my
job, and I'll come down and talk to you." He said, "Oh, no,
no. You're too important. I'll come up and talk to you."
Well, my logic was, "Okay, I'm not going to fight the man over
this. If he wants to, and it makes him feel better, I'll let
him come to Martinez."
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This is how that battle was won. You knew that you had the
battle won when this man insisted he would come to see you
because you were important. This is an interesting kind of
dynamic. So he was in my office in a matter of hours. I
explained the whole picture to him, how they couldn't get a new
school which they needed.
Crawford: Who was he?
Blum: Oh, he was an upholsterer, with a small business, and he was
probably the president of the chamber of commerce, as well as
the president of the association of all twenty-three community
organizations.
Crawford: Why didn't he want sewers?
Blum: Because it meant taxes he and all the other residents would
have had to pay. It would make his business and his home more
expensive to maintain, but, on the other hand, his whole future
was tied up in the community's growth so his upholstery
business would grow. All of his buddies are in business. The
folks who are key in this are typically small businessmen.
Crawford: So there weren't any big developers who were reaping big
financial rewards?
Blum: No, it wasn't that kind of a place. It was just little people.
So we sat and chatted for a while, and I said, "As I see it,
from where I sit, you'd be better off paying some more taxes
and getting in sewers, and getting a new school, and allowing
developers to build, and letting the place grow. Is that what
you want?" It sure was. He said, "Well, I didn't really
understand all this."
He went home, and late that night I got a phone call from
him. All twenty-three organizations had already met that
evening. They had reversed their position, and they were now
in favor of the sewers. That sewer bond went through with over
an 85 percent positive vote-- just unheard of.
Crawford: So there was finally some well-planned development in
connection with that issue?
Blum: Well, not really—unless you think unplanned development is
necessarily good, then we did it. But if, on the other hand,
you're not so sure about helter-skelter development, which it
was, in the sense that people are speculating on creating
various usages scattered over miles, then it's not well-planned
development. So we often push the community into becoming a
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modest disaster area, but possibly better than the one they
were already in. Well, this sort of thing just goes on and on.
Crawford: Are you working around shady practices?
Blum: Well, these are not shady practices. These are political
reality aspects of growth. These are issues that our society
has never decided to settle. Patchwork is how they get
settled. A health officer gets used to making case-by-case
decisions without having a satisfactory overall scheme to go by
until his community develops and legalizes specific standards
on how things are to be done.
In one Walnut Creek area, we had the same sort of battle,
and lo and behold, who's against the sewer? A couple of
physicians. They happen to own property and buildings, and
they are going to face more taxes, and they don't want to;
also, they have no problem themselves. These situations can be
fun because you go to a public meeting where the physician gets
up and makes a speech, and you're also a physician and have to
take up the opposite side of the issue.
I remember the Walnut Creek debate. The physician was a
fairly young man. I said to the attendees, "Let me tell you
about the health side, which the doctor doesn't seem to care
very much about."
Crawford: These would be public meetings?
Blum: Public meetings, and the doctor commenced to look like a bum.
Here he is, worried about his taxes—which aren't all that bad,
and he's making a good living—and the health officer is
concerned about getting rid of sewage out of schoolyards, and
sewage out of backyards, that sort of thing. Your medical
opponent creeps away, and you're so very virtuous, even if you
helped the neighborhood get into its mess to begin with by
okaying some development on septic tanks which you knew
couldn't hold up, no matter how well they complied with the
regulations when they built.
You could really question the ethics of all that behavior.
Yet no health officer could have stopped the initial
development; people had a right to use their land, as he would
soon find out. And you can question my ethics here, and do a
good job on it, too.
Crawford: Why?
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Blum: Well, because here I'm taking advantage of a situation to make
this guy look like a jerk, particularly because he's a doctor.
Crawford: He is_ a jerk.
Blum: Yes, he is a jerk, but only because he is unsophisticated about
the origins of the problem, which neither he nor I nor the
community will set right for the long term.
I bought a house, which was finished within a month or two
of the time I bought it. It was in an old neighborhood, a nice
neighborhood called Upper Lakewood in Walnut Creek. And,
little realizing—well, I guess I did realize—that the road
was not a public road; it was a private road. The water system
was a private water system although it was in the middle of
East Bay MUD territory but still, a private water system.
There was no maintenance for the roads, no maintenance for the
water system. So one moves into a situation like that. There
were sewers, thank god.
We'd no more than moved in when roads and water system
started falling apart in the whole neighborhood, and everybody
came to me: "You're the health officer. Fix it! Make
something happen, it's unhealthy."
I said, "But I don't run the roads department. The road is
owned by us. You can't ask the county to fix this road, we own
it." So there were long negotiations, but always with me in
the middle of this stupid mess because I am the county health
officer. Finally, all of us put up enough money, and paid the
county to come in and take care of the roads.
Crawford: You did?
Blum: All the owners did. Come Saturday afternoon, everybody is
getting cleaned up — I presume that was what was going on— and
there would be no water. You turn on the faucets, and the
faucets are gasping. Yet there is this big water tower that
everybody in the neighborhood could see, up on a high piece of
land, which was our water storage facility.
Crawford: But you couldn't buy into that?
Blum: Well, it was ours, but it turns out that the man whose house
was adjacent to it would turn off the water for the rest of the
community so that he could have water. It was just a limited
amount of water.
Crawford: And he was part of your private enclave?
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Blum: Yes! He was just one of us, but who's going to go up there and
hit him over the head with a wrench and open that tap? It
doesn't work that way. So we had these big meetings — a couple
hundred people. People would bring their kids. It was a real
picnic, but it was also serious because people couldn't get any
water to flush their toilets, take a bath, particularly on
weekends .
I remember one of these meetings. There was a resident who
was a bakery driver—kind of a red-faced fellow, cute, nice.
His wife was a cherubic, red- faced, little lady, and they had a
couple of cute little, cherubic, red- faced children. They'd
all come to the meetings and sit there and kind of chat at one
another in a nice way. The president of our neighborhood
association opened up the meeting about the water problem. We
had no more than started when some man raised his hand, he
wanted to speak, and it was the man who controlled the water
tower, who had the knobs under his thumb.
Crawford:
Blum:
The chairman said, "This is Mr. So-and-so," and this little
red-faced bakery guy jumps up and says, "So that ' s Mr. So-and-
so." Well, the audience got hysterical because they all knew
the name of the villain but didn't know him. That just
completely wiped out the credibility of this man, settled his
hash once and for all. He never even said a word. He sat
down.
Then we got into the business of discussing a new water
system. "This is going to cost this much and that much; and
what's the old system worth?" Well, it wasn't worth a damn at
best. I'm sitting there, cringing all the while, because the
health officer is supposed to be guaranteeing that you've got
clean water where you live, and up gets a lady who sort of
hysterically is saying, "This water system is worth thirty,
fifty, no, seventy thousand dollars." The bakery man calls
out, "Sold!" That was the end of that. [laughs] The meeting
dissolved peacefully, everybody put up their money, shut up,
and we bought into East Bay MUD.
Is that considered elitist, when you live in these private
enclaves?
Perhaps it was. The bad roads and decrepit water system could
have been the result of speculation, or in our case an example
of how little even well-off homeowners really understand about
what they are getting into when they choose a homesite. I sort
of knew what I was getting into. It was a lovely house by a
fine, careful builder, with good neighbors; not small matters.
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Crawford: Who was the architect?
Blum: I don't think there was any professional architect. The
builder's wife was the architect. She was a fun lady. They
lived just across the street from us. We always got along
well. He did beautiful work. His name was Curt Muller. He
was a subdivider, too; lived there for fifteen or sixteen years
until he had built on all the parcels he owned.
The bakery truck driver, whom you wouldn't think of as
being the great solver of problems, got rid of the old rascal
who used to screw up our water system; got rid of the lady who
was getting hysterical about how valuable our present junk
system was. That must have been the tenth meeting we had, and
if it hadn't been for this driver, we'd have had ten more.
Crawford: What were the forces out there? You said that labor was very
strong?
Blum: In a situation like that, labor was irrelevant. It was
strictly a problem for the homeowners. The developers would be
on the side of fixing things because they're going to sell, but
there weren't many big developers. Our builder was one of the
many small ones. They built four or five homes, ten homes at
the most. So it was no big deal. There's nobody to bribe;
there's just a past history of doing your own thing until the
mix got intolerable.
A Privately Owned Development; A Municipal Utility District
Blum: One special developer came into the county. He and his mother
and father got their hands on a huge piece of land—thousands
of acres. This land surrounded the Mt. Diablo Country Club.
That's a nice spot with a large golf course. The developer
formed a district, a municipal utility district—just these
three people governed it—and it had as much legal standing as
East Bay MUD. They did whatever they felt was necessary, and
they wrote their own sanitary laws. The only people who had
any supervision over them at all was the state health
department. We could go and admire and scream, but the county
health department had nothing to say about it.
fi
Blum: They were going to build several hundred homes, and they built
at least fifty to begin with. The sewage all ran by gravity
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down to a big sump. There they had big pumps which pumped the
sewage back up to the top of the mountain behind the Diablo
Country Club. There they had built a huge dam to hold the
sewage. Around the perimeter of the dam they had a pumping
system with sprays so that the sewage was sprayed up in the air
to evaporate, and the State Health Department approved this--
the last word in modern something or other.
We were pretty sure it was a disaster area. It turned out
that these subdividers, who were totally unscrupulous, used a
six- inch pipe to pump the sewage up to the top of the mountain
--it was about a mile—and they used second-hand invasion pipe,
which had been through the war in Europe. It wasn't very good,
[laughter]
Crawford: Is piping that expensive?
Blum: Oh, yes, it costs a fortune; and this stuff was the cheapest
kind to begin with-- just for the invasion of Normandy. Then it
was brought back to the United States, and this outfit used it
to pump sewage up a mountain. They also had inadvertently put
the big pumps in on a slant so that the bearings burnt out
every few days and the pumping system would come to a halt.
Then they would put in new bearings, which might take a week or
two or three. The people who set it up now were out of it.
The folks who were stuck with it were the members of the
utility district, meaning the folks who bought homes there.
The developers settled in Australia with which we have no
extradition treaty.
Crawford: They were criminals, basically?
Blum: Yes.
Crawford: But the state was passing it?
Blum: Passed it. They probably had over fifty homes built. They
were inexpensive in those days; $8,000 for a home. Most folks
could afford one by getting a near total mortgage. It was a
lovely spot, overlooking the country club, nice oak trees
around. One day one of our sanitarians came in the office and
announced, "I've been up there looking at this dam. The
squirrels are tunneling in it, and it's going to go. It's an
earthen dam, and it has started dripping a little bit."
Crawford: Just a dam of sewage?
Blum: Yes, of sewage. "Of course," he said, "the sprinkler system up
there isn't working, and there's much more sewage than they
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thought they would have to deal with, volumes of it in the dam.
It's going to go. I don't know what day or what hour, but it's
going to go." And while he's talking it goes. It floods over
the Mt. Diablo Country Club, over the golf course, and catches
all the golfers by surprise.
Crawford: Is this raw sewage we're talking about?
Blum: Yes, it's raw, just that it's been pumped up a hill. So that
was the end of that sewage system. Before it went, every so
often we'd go look at it because the invasion pipes would be
giving out, and we made them put these huge patches all along
the invasion pipe. And the pump doesn't work half the time.
It was a wild mess and you could see the end coming. So when
it went, we ended up putting an "unoccupiable" sign on every
single house. All these families were forced out of their
houses, and these were not rich people, left with an unusable
house and payments on their mortgage.
Crawford: Permanently?
Blum: Well, until something could be done. This went on a year or
two, and that forced the issue of Contra Costa Central Sanitary
District putting in a sewer all the way past Danville,
essentially to San Ramon.
Crawford: Did the sanitation situation eventually work out?
Blum: Yes, eventually, when Central San took the job on.
Crawford: That must have been very uncomfortable for you all the time.
Blum: It's a game, all the time, but it is perfectly legal. However,
the state's approval of that horrible system was unbelievable.
Our men wouldn't approve it, but the state did. Yet I doubt
that there were any bribes involved, just the lure of
developing California.
Crawford: Could you get that approved today?
Blum: We might. I'm sure worse things are approved all the time, but
not routinely.
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Dealing with the AEC and other Federal and State Watchdog
Agencies ##
Blum: A most alarming situation occurred when we discovered that the
AEC, the national Atomic Energy Commission whose infamy was
highlighted by Tom Lehrer's little ditties, was operant in our
county. They had taken over an old abandoned cement plant and
were putting radioactive contaminated wastes in secondhand oil
drums with plastic liners. Pieces of contaminated equipment as
well as liquids and various solids were mixed in with cement
and water and allowed to solidify in the oil drums which were
then sealed. The drums were hauled to a Sacramento River site
adjacent to where Antioch was obtaining its city water. They
were placed on tiltable racks on a small ship, taken to the
Farallones and dumped overboard to sink to the ocean bottom.
This was a brilliantly conceived, somewhat less than long-term
method of radioactive contaminated material disposal.
Our inspectors had chanced on it at the Antioch waterfront,
brought along a Geiger counter, and discovered that the
secondhand drums were leaking radioactive materials at the
Antioch water intake even as they were being loaded for their
burial at sea. The inspectors took the boat ride to the
Farallones and discovered that not all barrels sank, some
having more air than concrete. The AEC remedy was simple: they
carried a rifle and shot the floating barrels to let out the
air so that they gurgled and sank—so much for long-term
entombment .
Sounds unbelievable, but it was worse. When I got on the
phone to the local AEC operation, they made it clear that no
stupid local health officer could mess around in their
business, and would I please shut up and go home. My response
was pretty automatic: padlock the cement plant, close out the
loading dock, and remove the ship and all vestiges of the river
site operation by morning. If we found any evidence of AEC
activity remaining, there would be a press briefing at mid-
morning at the shipping and plant sites explaining how the AEC
was exposing the users of Antioch water to a mindless
radioactive disposal operation. It was all gone. Years later,
I met the physician in charge whom I had called and he made it
clear that there never had been such an operation as the one I
described. Thus one built trust of federal agencies.
A similar kind of event occurred around a grapefruit
incident. A man bought Arizona grapefruit from a truck in
Lafayette, drove on home to San Jose, started to eat the
grapefruit, and got violently ill. The Santa Clara County
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Health Department was called, checked it out, and found cyanide
in the grapefruit. Was this a murder attempt, some accident,
or something to do with the life of a grapefruit this day and
age? They called us, we found the vendor, bought a good many
sacks of fruit, and found cyanide inside many grapefruit.
Quick calls to the state health department, state
agricultural department, the USPHS, and the U.S. Department of
Agriculture gave us no information. But they all warned us not
to go to the press to warn people of the danger because it
would be bad for the grapefruit industry. A very impressive
concern for the public's health. We made it clear that we
would go to the press that day unless the whole matter was
cleared up.
It turned out that Arizona and Texas grapefruit were given
a cyanide spray at the California border for some irrelevant
plant pest so as to put Arizona and Texas grapefruit at an
economic or cost disadvantage. If the sprayed fruit in open
trucks got into a rain, the cyanide spray would be dissolved
and would go through the skin and poison the meat of the
grapefruit .
That border control process discontinued that day.
Anne Leslie; "Office Wife'
Crawford: We haven't talked about your staff.
Blum: At the very heart of it was Anne Leslie — she was my office
wife.
Anne was a very pretty, friendly but feisty person, about
my age--who was the health officer's secretary when I got
there. So I took her on as my secretary, and was I ever lucky.
She was quite diffident about herself and her family, only
recently did I learn that her father had been an Oxford don.
She was very defensive of me and used to describe herself
as my office wife. She and my domestic wife formed a close
team as they became good friends with at least one task in
common, keeping me afloat.
When we became involved in vaccinating everyone in the
county for polio, it turned out that my long-planned tour of
Europe's health programs found me in Finland at Mannerheim's
173
gravesite on the Sunday that the department did probably 50,000
persons by taking over a few shopping malls. I must say that I
enjoyed that day, was sure our people would cover all the
bases, and they did. When I got back I asked Anne if she had
had a decent, restful time of it while 1 was gone, no
dictation, no arranging, no appointments, no grant projects to
write up. In her charming and delightful way she asked, "Whom
do you think runs the department and makes all the decisions
while you are gone? Sure, we have well-paid assistant
directors in charge, but what do they do when you aren't here
for a final okay? They come in and say, 'Anne, what would the
boss have done about this?' That's a lot of responsibility."
I could just see it once she painted the picture. Probably
happens in lots of places.
She had a wonderful trait of being able to deliver a well-
deserved comeuppance to people who deserved one. As soon as I
became health officer I asked for a half day off per week with
pay for me and for any of my assistants who wished to teach or
participate in university courses. I taught Friday afternoons
in internal medicine at Stanford University Medical School — in
many ways the highlight of each week. One Friday Anne called
me there at about 4:00 to tell me that she had had a most
unpleasant encounter with a prominent Richmond attorney who
wanted to talk to me. When she told him that I wasn't in, he
wanted to know where the health officer was and why wasn't he
at his desk. When she said she could get me at Stanford
Medical School where I was teaching, he became even more
unpleasant and wanted to know how it was that a county employee
could be working elsewhere on county time.
He went on to say that when anyone wanted to reach him, he
was always at his desk. This had been too much for my Anne,
and she came back ever so sweetly, I'm sure, "My, it's too bad
that you have such a poor practice!" This concluded their
conversation and she then called me, fearing that she may have
made us a lifelong enemy.
When I called him back the following Monday, he made some
remark about my having a delightful secretary. A few months
later, he called her to see if she would come to work for him.
The Civil Service and Other Frustrations
Crawford: What were the most frustrating things, and what were the
biggest accomplishments in Contra Costa?
174
Blum: Oh, I don't know. The reason I probably left, ultimately, was
I was simply getting tired of recurring hassles such as those
with the civil service. The county was very much pro-labor,
and civil service was strong. You couldn't kick employees
around, that was good, but the civil service department somehow
got the notion that they were the saviors of mankind. Every
time the health department had a job to fill, they would decide
what kind of person we needed. I know about health and health
care--but they would come over with the specs, and say, "Okay.
You've got a job. Here's what we're going to advertise and get
for you." I said, "The hell you are. That's not what we need
or want. It's not what we asked for. It's not what was
approved for us." I was so sick of it, and I wasn't the only
one. George Degnan felt the same way because of the county
hospital's needs. But I hated to join forces with him because
he was such a notorious rule-breaker.
So I stalled, and that may have been a mistake because we
could have gotten rid of civil service at the time. However,
if we had broken the civil service department, then we would
have the problem of getting people that the board of
supervisors wanted to hire. If we didn't have something like a
merit service, the board of supervisors could say, "Well, Mary
Jones would be good for that. Why don't you hire Mary Jones?"
The spoils system would be back.
Crawford: They put that kind of pressure on?
Blum: Well, they used to before my time, but that was all gone in my
day. Civil service had gotten rid of it. So there was a very
strong, good side to the civil service. They ultimately
brought us well-qualified people, by and large, so I was always
reluctant to help break their necks, but it was more than I
could stand to always be told that we needed the wrong kind of
people. If the specs were wrong, then you spent six months or
a year hassling civil service, and might spend more time before
finally getting the board of supervisors to tell them, "Okay,
this is what we want." Another monotonous event every year
was, "You have to cut the budget." Or somebody would bring in
a new issue which was in fact ancient. I had a drawer of
scenarios that was kind of a joke--when you'd get one of the
repeat issues you'd say, "Oh, that's started again," you'd pull
out the drawer and you get the folder, and say, "This is the
scenario we have to follow to handle this issue."
Crawford: Same rigmarole?
Blum: Same rigmarole of what you're going to have to fight, except it
might take longer this time, or shorter, whatever; but there's
175
a point at which you get tired of seeing the old scenarios
dusted off, although they're very helpful.
II
Blum: One interesting case is worth recording. One of the more
unpleasant duties of a CEO is demoting or firing a longtime
employee who is well liked but less than useful. As I began my
drop-in inspections of restaurants, I discovered that the
territory of one of the inspectors would never lead anyone to
expect the presence of a health department or a sanitary
inspector. I went through all his functions with him at his
next review, put them in writing in his folder. The next year
my surprise visits found no improvement. This time I called
him in and demoted him to a lesser rank.
His fellow inspectors and their supervisors didn't like
this ugly new phenomenon, hired a lawyer, and asked for a
hearing at the Civil Service Commission. Their lawyer was a
very popular fellow, and in fact, our congressman at the time,
for whom I had voted, no less. He knew me well, told me I
didn't have a chance with the pro-labor commission, and should
rescind my action before the hearing, which he assured me would
be a trial about me, not about my sanitarian. I told him that
there wasn't going to be any turning back, that the demotion
was deserved, and if lawyers like himself were inclined to
lessen the quality of county services, that was their
prerogative.
The hearing went as predicted and the inspector was
reinstated. However, my ratings of his work and reasons for
them were made a matter of public record, and I looked pretty
good in a situation where Tightness was irrelevant. The net
result was very good. No other employee wanted a night in the
bright lights, so what 1 put in their ratings became very
meaningful from then on.
A few years later when I was at the university, I was asked
to give an evening lecture on aging and mental health in Contra
Costa. There were about 400 people in attendance and who
should be sitting in the front row nodding and smiling at me
but this same sanitarian and his wife, who was also a health
department nurse. When it was all over they clapped and
clapped, and came up to tell me how nice it was to see me
again. That was the nicest part of the evening.
it
Crawford: So those were some of the frustrations?
176
Blum: There were frustrations. On the other hand, though, as you
look over my files, you'll see the number of papers we wrote,
and the number of areas we worked in; it was fun. We had a
school health program that was years ahead of its time—we did
some work on genetics counseling—that was twenty years ahead
of its time.
Crawford: And you said you could get funding easily?
Blum: Yes. If you didn't get it from the county, you'd get grants.
Everybody's so interested in what you're doing that you can
find money here and money there— the TB Association, the Heart
Association, the Mental Health Association.
More about the Mental Health Program, and Serving with the
Space Cadets: 1956-1965
Crawford: How would your county have stacked up with San Francisco in
mental health, at that point? Or another county?
Blum: Well, it was just backwoods [in the beginning]. There were no
services. San Francisco had a million agencies to do
everything, and still does. It doesn't mean they do well; they
often do badly, but at least it had those things. Instead of
talking about setting up an agency to do psychiatric help, we
said, "Well, let's have the teachers do a better job; let's
have the cops do a better job," the nurses, the social workers,
and so on. It was a big thing, but, in turn, it led to the
demand for more specializing. The psychiatrists worked as
consultants in the program. That's how they got their foot in
the door, and they could make a living. They'd be hired for so
many hours a day to work with the school teachers or with the
nurses or with the police, or whatever. It was a big program.
It was kind of fun, and it resulted, ultimately, thanks in
good part to Leonard Duhl, that I worked with the National
Institute of Mental Health for years. I was on several of
their committees awarding grants, studying various issues.
Crawford: While you were in Contra Costa?
Blum: In Contra Costa, yes. It really started with Len Duhl and
something he called the Space Cadets. He convened a committee
for NIMH, "Social and Physical Environment Variables as
Determinants of Mental Health"— pretty wild. Len called the
committee the "Space Cadets." He was the first health planner
177
Crawford :
Blum:
in the National Institute of Mental Health, although they
didn't call him a planner, but that's what he was.
He and I had spent a lot of time wandering around the
county, studying all these issues of sewage and health and
schools—you name it—during his two years with us. He and I
were very well aware of the fact that important issues are not
going to be solved by any one discipline. There was no way;
the issues are much too broad, involved all kinds of people.
So in 1956 he had created the Space Cadets, made up of
people from every major discipline—the famous lay worker Alice
Day from the Catholic church; Doxiodes, the world-famous
planner from Greece. He had this man Miller, who founded the
general systems theory in this country, from the University of
Chicago; he had an astrophysicist from Chicago, Rashevsky. He
had some wonderful sociologists and anthropologists— Sandy
Hollingshead from Yale. Then he had Sir Jeffrey Vickers from
England, and the head sister from Webster College, Jacqueline.
She left the order, ultimately, and became the president of
City College of New York, and married a Jewish banker. She was
something else; she was fantastic. Mel Weber from Berkeley,
and before Mel Weber, Catherine Bauer, who was Mrs. William
Wurster— a famous planner, housing expert, in her own right.
So there were all these and many more interestingly placed
people from different parts of the world. We met for three
days at a time three or four times a year, usually in D.C.
In Washington?
Usually, not always. Duhl was putting these people together
and, for at least the first year, every one of these people
would spend a half a day describing to the group what he or she
was doing or what they felt they were doing, and then everybody
else would chew on it. It turned out we didn't understand one
another's work, not even their vocabularies. It was a very
interesting learning experience.
All these people— many of them world- famous --really didn't
understand what the others were doing. John Seeley, the
Canadian sociologist, was there, and it fell to him to sum up
briefly what each person seemed to be doing. Usually, the
people who had been the subject for the day wrote down
everything he said, because it was usually a lot clearer than
what they had just told us. It was a fantastic experience for
me, a country hick, you know. Also from Berkeley, there was
Alex Meikle John- -the world-famous educator and expert on
178
constitutional law, and, ultimately, Scott Buchanon from
Annapolis --St. John's Academy.
Crawford: All these people were on the committee?
Blum: The committee, yes. That is what I was exposed to, and these
people had all, more or less, been involved in academia, and I
had not. They were used to philosophizing on the world's major
issues, but not even they were aware of the confusion and
relationships between the outlooks of the various disciplines,
particularly when the group focused on clarifying an issue or a
societal need.
Crawford: What years were these?
Blum: We started out in 1956, and it ran until '65--a tremendous
time. In 1956 I received this letter from Len Duhl saying,
"We'd like you to be a member of the Space Cadets," so I went
to the board of supervisors with the letter, and when you go
before the board this is public information- -and here we go,
Space Cadets. Well, I was Buck Rogers. All the newspaper
reporters were there, and the board was sort of looking at me
and smirking like, "Good Lord, this health officer hasn't got
an ounce of brains, coming with a request like that." I wasn't
asking for money, I was asking permission to be gone for three
days .
The chairman of the board, an attorney from Concord, said,
"Well, I don't think we're paying the doctor so that he can go
to Washington to join the Space Cadets." If you were an
officer of the county, you couldn't leave the county because of
an old California law that said you had to get permission from
the board to do so. There had been a long history of officers
leaving with whatever cash was lying around in their
department .
II
Blum: This was the first time I'd ever really asked for permission to
do anything, so the next board member gave his little spiel and
another and another member then said that it was ridiculous.
Finally, there was a new member of the board, Joe Silva,
about whom I shall elaborate—a wonderful man, a great big man
--who called himself a "black Portuguese." This was typically
his warning to stupid people to not throw around racial
epithets. The chairman said, "Well, Joe, what do you think?"
So Joe sort of sat back, and rocked in the fancy board chair,
and he said, "Well, you know, I used to be the mayor of
179
Brentwood"--it 's a little city in Contra Costa--and he said,
"One year I thought I ought to go to the meeting of the
California mayors, but the city council never would let our
mayor go to meetings. They didn't want to waste the money on
them, so I paid my own way, and what do you suppose I found?
We weren't even getting our share of the sales taxes. We had
never put in a request for our share of the money. Mr.
Chairman, I move that the doctor go to Washington."
One, two, three, four, five yes votes and I'm off to
Washington. This man used to run a roadhouse, and he became
the mayor of Brentwood; he was this and that and had been a
judge. He used to say he'd never been to school. He might
have been right. Other people said he'd been a football player
at Oklahoma in their great days. I never did know, really,
where Joe stood educationally.
Then it came up budget time. I remember I had to appear
before a little subcommittee—a couple of board members — and it
was after lunch, about two o'clock. Joe was a big eater, big
drinker. I don't mean a drunk, but he would have several
drinks at lunch, and eat big meals and so on. So this was
right after lunch and he just dozed off. The other man, who
was a real wisenheimer--a lawyer and a board member—was taking
apart our budget, and you sort of give ground because you have
to. If they don't get to cut your budget, well, then they feel
badly about themselves irrespective of whether it may or may
not be destructive or helpful to your department or the people
of the county.
So he was pleased with himself, he'd screwed up a half a
dozen things, and he shook Joe's shoulder, and he said, "Joe,
how do you feel about this budget?" Joe sort of shook his
head, woke up, and said, "Tom, you know how I feel about your
messing around with this budget. We're gonna buy a truck, but
we're not gonna have the guy to drive it. If we're going to
buy a typewriter, we're not going to have the secretary to type
on it. We're going to do some other damn fool thing. That's
what you always do with these budgets," and he went back to
sleep. Our budget was put to rights at this point.
Joe was a real philosopher from the sticks--! always
appreciated Joe. In recent times, he's made headlines. He's
been dead for some years. Recently it was ex-Mayor Christopher
from San Francisco who took the credit for having gotten Joe
Silva to vote for BART.
For BART to succeed, to go into business, it had to have
three counties of the five Bay Area counties, and in each of
180
the three counties, of course, at least three members of the
board of supervisors had to vote for it — three out of five.
Alameda and San Francisco, naturally, voted for it, and Contra
Costa was the only one left at that time. San Mateo wouldn't
do it.
Crawford: Marin didn't.
Blum: Marin didn't. Contra Costa was potentially for it. That
afternoon, I was presenting something or other to the board of
supervisors. Then they had an adjournment in the middle of the
afternoon, and I went into the little board room. Joe was in
there, and I was there with another man who ultimately became a
professor here.
Joe started soliloquizing. He said, "Now, this BART thing
is coming up this afternoon," and he said, "it isn't going far
up into the county, and everybody up there is against it
because they'll never see BART in their lifetime, and I won't
see it in my lifetime. So," he said, "we're split two and
two." Two supervisors at the west end of the county are for
it, two on the other end are against it. And Joe is way out
there — at the far end of the county, the Brentwood end. He
said, "I've got to decide what to do."
So for half an hour, I listened to him figure out what to
do. It was just magnificent. He thought of his brother-in-
law, who had an orchard. He said, "Now what '11 this do to him?
Well, the taxes will be about this and this, and if it's as
good as everybody says it is for the development of Contra
Costa, he'll get those advantages."
Crawford: So, very practical, pragmatic?
Blum: Fabulous. He thought of farm owners, he thought of school
teachers, he thought of businessmen. He said, "I can't see how
it would do any damage to any of them. The only person being
damaged would be me because they'll vote against me- -they '11
get mad—because BART is so far away. Well, I'll vote for it."
And we had BART. This is the same Joe Silva that sent me to
Washington. It really changed my whole life, too.
181
Being Considered for a Faculty Position at Harvard
Blum: In 1959, as our mental health work went sailing along, and as
we published a paper on its thrust,1 I was asked by Dr. Erich
Lindeman, Harvard's chief of psychiatry, to consider joining
his faculty in a community and administratively oriented mental
health position.
I had met Erich in 1949 when I took my M.P.H. at Harvard
and attended his class in community mental health. Erich had a
miserable squeaky voice, especially for a plump, cherubic, mid
sized man of fifty-five. I had assumed he was going to be our
worst lecturer. His course took place in one of the ancient
amphitheaters of Mass General Hospital (MGH) such as ether
anesthesia had been demonstrated in. Our huge class of about
100 was stacked from the central hole or working space up to
the rafters. Our first session was a demonstration of a
psychiatric therapeutic intervention. Erich was down in the
hole with just the young woman patient whom he was reassuring
in his squeaky voice that all the people above were his
friends; and that she could relax as he and she went about her
therapy session. Erich was a magician, she relaxed, and we all
became intent as we heard a magnificent therapeutic exchange.
Erich was promptly our favorite professor, whose presentations
we never missed.
When I received the offer to come to Boston, it seemed
unlikely that we would ever want to leave the Bay Area again,
as much as we had loved the Boston area a decade previously.
Our four years away from home had pretty well confirmed our
addiction to the Bay Area where both of us had been born and
grew up. But Harvard was Harvard, and we decided to give it a
try. We got an agreement to spend the month of September there
and make up our minds on the job, so to speak. I received
travel and living expenses and the equivalent of a month's
respectable professor's salary. We took leave from Contra
Costa and went via Canada with our bicycles anchored on the
back of our station wagon.
Boston was socked in every day we were there, no leaves
that year. Our motel was adequate, but didn't add much to the
ambiance. Some of my former students tried to cheer us up, but
that wasn't an unmitigated success. Visiting the Glimchers, in
'Blum, H.L., and W.A. Ketterer. "A Health Department's Activities in
Mental Health." Public Health Reports 78:7, 619-626, July 1958.
182
whose home we had lived ten years before, was the one
restorative and we had some fun times, including reminiscences.
The work with Erich was exciting and more. He asked me to
begin with a full review of all aspects of his department,
which included a tiny community center based at Wellesley, the
McLean Hospital outside Boston, and his immediate department at
Massachusetts General Hospital (MGH) . I soon discovered that
Erich had a significant inferiority complex and wanted me, an
administrator, to overcome all his imagined inadequacies as an
administrative head of a huge empire. It reminded me that in
Contra Costa our department had always used an outside
psychiatrist to keep us level-headed and honest, sort of a
magical amulet. In Boston, Erich felt that an administrator
was to do the same thing for a group of mental health
academics, whose department he felt was not functioning
adequately, even though it was probably the best one in the
U.S.
I started visiting the overall administrative entities at
MGH in which we were embedded. No one seemed depressed about
Erich's performance except Erich.
I learned a bit for myself when I interviewed the
administrative head of the private wing of the hospital. He
had a longstanding problem of persuading his personnel that
they were being fairly treated if they were not graduates of
the MGH programs. He had invited in the Boston Globe and
ingeniously given an interview about the background, origins,
and training of all of his department heads. It so happened
that very few had trained at MGH. As I interviewed him, he was
suffering from a barrage of complaints about how no one who was
trained at MGH had a chance to get ahead, overkill in spite of
his deft public exposure of the realities.
In Erich's own unit I soon gained the confidence of his
administrative people and was promptly urged to avoid letting
Erich buy any more recording devices—they had a closet full of
them. It seems that his lectures and public addresses were
typically a wild success and he wanted to capture them—hence
the recorders. What he overlooked was that he read any
audience like a book and what he gave them was so astutely on
the mark that he was indeed always enthusiastically received.
When such a talk was transcribed, there was no such audience
and the magic the talk had evoked was irrelevant to a
subsequent audience. This led to a never ending search for
better recording devices.
183
Erich had been carefully excluded by the Harvard Divinity
School from addressing its graduate students, apparently out of
fear that he would draw the best into the fold of psychiatric
counseling, a subject which was, of course, central to their
own divinity careers. As I arrived there, he had broken
through that taboo and was giving his first major address to
the divinity school classes. Prior to that their students had
to find time to join Erich's classes as best they could. He
had me go along, and for sure, it was another wild success and
probably did result in the feared student defections. It was
all too clear that the lecture by itself without the presence
of its intended audience wasn't going to be nearly as exciting.
We got that point across subsequently.
Mrs. Lindeman, who was an outstanding psychiatric social
worker, regarded me as an anathema because she saw that Erich
might be bamboozled into letting an administrator take control.
However, at the end of three weeks I told him that there was no
likelihood that I would ever live happily in Boston, much as I
would like to be with him at Harvard. We set aside a full day
for a recounting and discussion of my observations. On that
day he invited me into his inner office and offered me the
reclining chair next to his desk. I declined, telling him that
roles were reversed, that he was the client and I was the
therapist. He was a good sport and took the recliner.
I began on my list of observations. He was bitterly
unhappy that few of his division chiefs came to his weekly
staff meetings on time and many hardly ever came. I pointed
out that when he had been brought to Harvard a few years
previously, he had been directed to create the finest
department extant. In turn, he had recruited each of his
division chiefs as the keenest person in their area and each
was told that all that was expected of them was being the best
in their field, and keeping Harvard number one. None had ever
been told that Erich meant to supervise them or have them
participate in staff meetings. He had sought out potential
prima donnas . Did he want to change them now that he had them?
I indicated that if I were the boss and wanted these associates
to toe the line and come to staff meetings, they would, or they
wouldn't be there very long. So did he really want them to
show, given that each was bringing fame to Harvard, as was he,
and if they didn't, would he really pursue their replacement
insofar as the Harvard structure would allow? He seemed to say
that yes, he would demand their cooperation. I couldn't let
this show of bravado go as Erich wouldn't push a cat out of his
way. So I said, "Would you really let someone go?" He slowly
allowed that he'd have lots of trouble even talking about it,
184
and I suggested that he live within his own capabilities and
stop torturing himself.
I tried to leave him with my belief that he was
administering in a way that was right for him and that the
proof of the pudding was the quality of the department,
discipline or no.
The next day, my last one, I got a call from Mrs. Lindeman,
who was gasping with an upper respiratory problem, apologizing
profusely that she couldn't send me off appropriately, that she
had come to appreciate my help for Erich, that I really wasn't
the threat she had feared originally. So we left happily and
never regretted what was a good time after all, reunion with
our friends the Glimchers, and a chance to bicycle in some of
the eastern Canadian provinces as well.
Co-Authoring a Book about Administration; 1963; A Housing
Project in East St. Louis; Lincoln Hospital in New York ##
Crawford: That was your first consulting then, wasn't it?
Blum: First big-time, yes. Not really consulting, just participating
at this level.
As another benefit from working on the Space Cadets, I got
acquainted with Alex Meiklejohn and commenced to understand
what our constitution was about. I came home, and I said,
"I've got to learn about and then write a book on
administration because what we're doing is a joke; it's a
travesty, and the books I've studied are irrelevant. We're
paying no attention to the history of this country or to our
political and cultural heritage in the course of administering
a county agency. As an administrative agency of government, we
ought to be in line with our people and our country."
It led me to write a book that was way ahead of its time-
twenty-five years ahead of its time.1 All the traditional rules
of administration that I'd been taught were garbage. That's
the reason the teachings on administration changed every five
to ten years--a whole new look. There were a whole set of
interests that had been left out at one time, then another set
'Blum, H.L., and A.L. Leonard, Public Administration; A Public Health
Viewpoint. The Macmillan Co., 1963.
185
of interests at the next look, and so on. The book was devoted
to looking at all the interests that have to be relevant to a
health department. Its own doctors are one group, its own
nurses are another. Nurses typically were the first
professionals in their family; they don't see the world like
doctors do.
Crawford: You have a lot of respect for nurses.
Blum: Oh, yes. They did the real work for the health department,
there was no question. That was where it was at. That was a
strong nursing group in Contra Costa; the guts of the
department.
Then, as you look at other people in the department, you
realize their backgrounds are very different. But more
importantly, when you look at the consumers that you're dealing
with, there are all kinds of them ranging from Orinda and
Moraga to far into Pittsburg, or enclaves that don't even know
English. So your clients are all different; you can't pursue
the same approaches with all of them. This is what America is
really all about, or should be.
So I found another health officer by the name of Al Leonard
who thought like I did—the only thing wrong with our writing a
book together was that we agreed on almost everything. The
book was released by Macmillan in 1963, and that book opened
the door for me to become a professor. The book was pretty
eloquent thinking for me. All the other things I had done were
clearly diverse--! was not specializing in anything; I worked
on one thing, went on to the next, and the next, and the next.
But the diversity of issues and the diversity of the people or
interests involved got me thinking, and this book wrapped it
all up with the message that administration had to be built
around taking differences into account. It was a systems view
before I understood what systems thinking was all about.
At that committee of Space Cadets we did a lot of fun
things- -we explored. I ended up visiting East St. Louis long
before its housing was blown up, before it had become known for
the jungle it was. The government built all this wonderful
housing and then blew it up in recent years. It was
intolerable, a ghetto that was a dozen stories high and solid
with trouble.
I was a consultant for a lot of issues--! got on other
committees as a result of that one. Some of them were granting
funds for mental health projects. I made the field visit to
Lincoln Hospital in New York for National Institute of Mental
186
Crawford:
Blum:
Crawford:
Blum:
Health (NIMH) --the one that became so famous because the
workers took it over. My wife was accompanying me, and when we
got there for the NIMH annual visit for renewing the grant, the
workers had taken over the whole place that morning. It was a
far-out, fantastic situation. We got there early, and we were
welcomed by some of the workers who had taken over.
In anticipation of your coming?
It's possible, but we never heard that. I think the takeover
was in the wind for a long time. We got into a little old
Volkswagen, and a black man--a big, heavy-set guy--started
taking us around, showing us the community and all the various
little extra clinics and things that related to Lincoln
Hospital. Books have been written about it; Fitzhugh Mullen
wrote a book about it. He is an important figure in the
Clinton administration somewhere,
physician.
He's a fine person, also a
In any event, it was a pretty tense day, and so we were
kept away from the hospital for about the first half day, and
instead looked at all the little ancillary things they were
doing. I remember this man showing us a Puerto Rican grocery
store on a corner, just across from a city park—this was South
Bronx country—and saying, "That man is a dope dealer. He's
killed so many of our people." He said, "He has to stop
selling drugs. We're not going to put up with it anymore.
There he is out there in the park with his little ice cream
wagon, and he's peddling dope. He's been warned." He said,
"We'll bring boys in from across town, and he will be gone."
And he was; he was killed shortly thereafter.
Really?
Oh, yes. They were playing for keeps. This was a community
saying, "We just can't tolerate these parasites who are
destroying our kids and our families." And this is a mental
health clinic!
Then we went here, we went there, and finally came back to
the headquarters, and things were cooling down, and people were
taking on duties. Some of the docs were there.
In any event, at the end of the day, they let the director
of the clinic in so I could see him. The director of the
clinic was a famous psychiatrist; I'm trying to think of his
name. He went to UCLA from New York, as I recollect. I knew
this man because we were on many of the same committees in
Washington, D.C. So I reminded him, "You know, when you sold
187
us on this project, you presented what you wanted to do here,
and one of the things you told us was that if this were really
a success, they'd kick your ass out of here at the end of the
year." I said, "Do you know what? This is a year, today." I
said, [laughter] "Get your ass out of here. You're a success."
Crawford: That's a really charitable evaluation, I would say.
Blum: He was really furious. He wasn't the least bit happy, but the
truth of the matter is that there was some virtue to his
prognostication, and to the fact that it could happen, and that
people could run it without him for a day or two. In any
event , I think we ended up giving them the money again for the
next year, and the lesser staff and the patients earned the
right to a lot more say in the operation.
Crawford: That's great. Did you write about that?
Funding for Navajo Projects
Blum: No, I didn't. That was just part of the job. Then I remember
we went to see the Navajos, who were asking us to train a few
medicine men. We gave them the money for training medicine
men, which lasted for quite a few years; because the
practitioners were dying out, they were disappearing. What was
clearly evident when you visited them was that there were
Indians who wouldn't, for example, take treatment for TB
without the intervention of the medicine man, and the
physicians might not get to treat a tubercular patient without
the family participation that the medicine man brought to the
relationship.
Crawford: Was that controversial?
Blum: Well, sure, very; but I had a wonderful couple of committees
that I was on because I was free-wheeling and didn't know all
the rules. It looked like a good idea, and when we talked to
the Anglo doctors out there, we could see why they wanted it.
It wasn't just a notion of the Navajos; so many of them can't
receive our therapy until they're all quieted down, and, of
course, much of the medicine man's routine is reconciling
people with their families. People don't appreciate that, but
they bring families together.
People whose families are split apart, and people who are
very disturbed, are all brought together with a ceremony for a
188
day or a week or a couple of weeks. When the ceremony is over,
they're kind of all together again, and now the sick person can
go on with his or her life, or with Western medical care.
I remember going up to this big mental hospital near the
airport between Tacoma and Seattle and making the site visit;
we turned over big grants to those people. Ex-patients were
starting to do therapy on the new patients. It was kind of
like that San Pablo thing—if you got people who could relate
to others in trouble because of experiences in common and could
use information positively, it was possible to reach people you
otherwise couldn't reach.
So that was an interesting use of ex-patients, and it was
good for them, of course. Alcoholics Anonymous, in many ways,
is doing that. They're keeping themselves well by helping
others. It was not all that different. There were things that
were similar, and we were the NIMH committee that made those
decisions. I did that for quite a few years for NIMH. That
all started with Len Duhl and his creation, the Space Cadets.
And that is how I became an academician.
The Multipurpose Worker and the Rodeo Center: 1964
Crawford: Well, we didn't talk about that multipurpose worker yet. Do
you want to talk about your research in that area?
Blum: Well, that was a dream, also, because part of the thinking
about how you could help people who were unhealthy had
something to do with how you could reach them, and something to
do with what caused the problems. What became clear as one
looked around the health department was that the same people
were in trouble on multiple fronts, and our one-discipline
professional workers didn't always reach them.
We found that the same family had all kinds of health
problems, endless--and was also having all kinds of probation
problems and welfare problems. So we got to looking at it,
wondering if we could really separate the health work from the
welfare work from the probation work from mental health work--
could you really do patient care by having an army of
specialists, each working on one aspect of a person's problems?
You've got to put one person's problems together, and treat all
of a person with good timing as to what is a priority. A
multiprofessional team as a basis with one or another member
carrying the therapy is ideal. A cross-trained professional
189
doing the basic work with the team in the background was our
goal.
Crawford: Goes way back.
Blum: Goes way back. I mean, folks were writing about this two
thousand years ago. We wanted to give it a practical trial, so
we cooked up what we called the multipurpose worker; well, it
was really a multiservice operation; multipurpose worker was a
poor term because that got us into nothing but trouble with all
the workers. Nobody wants to be multipurpose; everybody wants
to be specialized.
We approached the little community, Rodeo, because they
were isolated. They agreed: yes, they would love such a
service center. We said, "We'll give you a health center, and
out of this health center will work mental health workers,
nurses, social workers, probation workers; and the county
services will be available to you, near at hand. We can't
always get you what you need here, but they'll be made
available as soon as we know what you need."
I got an agreement from our wise county administrator to
pull all this stuff together. We asked the probation and the
health and the welfare departments and the school district,
which was independent, to give us the names of the families in
trouble that they were working on. It turns out that there
were five extended families who were the crux of much of that,
as is usual--a few people are taking all the services and have
all the trouble — these five families have a couple dozen
people, and they're always in trouble.
We asked each agency how many workers they had working on
these families, and what kinds of workers. At first count we
found ninety workers serving these five families over the past
couple of years—so you know the kind of money the county was
spending on them. I dragged that information over to the
county administrator- -he was a character—and he said, "Oh,
you're crazy. It can't be. You go back and count. There's no
way we can have ninety workers in a little town like Rodeo."
Well, it turned out we had forgotten to count the probation
workers. By the time we added it all up, there were a hundred
and twenty workers .
So I applied for a grant, and we got a half a million
dollars , which we never really got in the long run because
that's when I came to the university, and the USPHS would no
longer give the county the grant when I was gone.
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Crawford: What happened to the project?
Blum: Well, it stayed on without any grants, and it worked for about
ten years, from about 1964 to 1974. Each of the departments
picked the worker who was appropriate, and in several cases it
was the worker who was already in Rodeo, but in our nursing
department that wasn't true. It turned out that our nurses
were berating any nurse who wanted to go there, saying, "This
is betraying nursing."
Crawford: Kind of looked down on it as compromising?
Blum: Compromising, yes.
Crawford: Is it possible to do all those things—be an employment
counselor, and social worker, and so on?
Blum: No, but you can be the basic person. In other words, you're
the primary person, and you obtain more refined expertise when
you need it. It's like the physician world. The primary care
practitioner can do 90 percent of it, and that was really what
that was all about, except we weren't going to base it on
physicians. It was based around nurses and social workers.
The probation department had all trained social workers, too.
Crawford: How did the doctors like it?
Blum: I never heard from them because they still got their referrals.
They were outside the team, you see. They got referrals; they
did their work, and paid no attention to it, basically. But
our workers held the families together.
Before we got started in the field, we had a little session
with the big shots of the four county departments and the
school district that was involved. We pulled the five family
cases with the charts from each agency. The very first one we
pulled--a very small family—involved a girl that the health
department knew because we had spent a fortune on her through
our crippled children's program. She had had this done, and
that done, and she never really thrived. She was just a poor,
miserable little kid; she was not retarded or anything like
that. The assigned nurse "knew all about" the case. All these
workers from the four departments knew the case, or so they
claimed.
Contra Costa had very elegant human services programs, of
which all the workers were very proud. It really was a
remarkably good setup—still is. They knew all about the case
that was there— boasted they knew their cases.
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Then welfare described the problems with the family: a
ne'er-do-well father and a mother who was not with it, and so
on. They verified what the nurse had to say from the health
department perspective.
Probation didn't want to talk. We said, "Come off it.
This is part of your assignment. You're delegated to sit in on
this and go to work—never mind fooling around." So they gave
us what they knew about the case, which was a case of incest
with this little girl, and all that the health department
didn't know about the little girl was about the incest, and all
that welfare didn't know about this family was the incest- -what
was the matter with the girl, and what was the matter with the
mother. Just shows you what you don't know if you're coming at
it from a health standpoint or a welfare or a school or a
probation standpoint. This was the first case we studied.
That stopped all the nonsense, and really brought everybody
together in a hurry because we obviously didn't know a damn
thing unless we could see the whole case. Yet this is what the
rest of the world still does. Nobody ever looks at the whole
person if they can avoid it.
We opened up the Rodeo Multipurpose Center; the citizens
had a big meeting and told us what they wanted out of it, and
everybody was looking kind of happy. Of course, nobody knew
about this first case—but everybody seemed to be moving with
the intent and the spirit of having a nearby, easily reached
center of their own.
We hired a wonderful secretary--a half dozen professional
people in the office picked this girl out. She was somebody
who had worked around the community as a secretary. Then after
a couple of months, we commenced to get the impression that
folks were coming in to see the secretary. This was not a new
experience for us. We'd had this happen in alcoholism clinics
before. She was a great gal. She could take care of many of
the patients' problems, and then she would line them up if they
needed expertise—with the nurse or the social worker,
probation worker, mental health worker— whoever was necessary.
So it was this common little theme of being able to talk to a
good human being that was meaningful to people seeking help
with whatever kind of a problem they had- -truly one stop.
Then the nurse and social worker in the office said, "Can
we break the routine? Instead of asking the patient to wait
until the right person comes back because the secretary says,
'I think you really should see the nurse,' that whoever is in
the office take these cases from the secretary. In this way
192
there would always be a professional available in the office,
and the patient wouldn't have to come back another day."
This was the multipurpose approach. By experience, all the
workers were discovering that most of them could do much of the
work for any of the cases. Our nurses knew everything the
welfare workers did, and vice versa to a great extent—not the
detailed health care stuff, but very close to it. The net
result was that that's how the center began to operate. The
secretary would see people, then would assign them to whoever
was in unless it was clear-cut they had to go to special care,
which was arranged. This approach changed the life of the
center, and it really worked; it worked beautifully.
Crawford: And you had to come into the center?
Blum: The center was in Rodeo, and just for Rodeo residents.
Otherwise, our offices for the people in the area were in
Richmond, and the welfare offices were in a different building
in Richmond; the mental health—well, hell, they were in
Martinez; the school people were in Rodeo. The workers came to
the center and were available to the locals. Previously the
people traveled to one or more of these offices. There was no
public transportation and patients were killing themselves over
keeping conflicting appointment times and places. I finally
saw this Rodeo approach in real operation in Canada years
later; in Australia; in Finland; in Sweden.
Crawford: Before your work on the Rodeo center you gathered data on
multipurpose workers in Europe, didn't you?
Blum: Yes, I went to France and England and to Denmark and Finland.
I told you about Ollie Randall. She was the Ford Foundation's
super social work consultant, and she heard that we were
working at putting this together in 1960-61.
Crawford: She'd been working in the field after World War I?
Blum: Yes. She came to visit us — looked us up—and wanted to hear
about this multipurpose worker thing, and she was so pleased,
and said, "Well, this is fabulous. You know what? At the end
of World War I, when I was working in France, we set this up
there." [laughter]
Crawford: Similar thing?
193
Studying Health Care Systems in Europe on a 1962 WHO Fellowship
and a Later Study of Health Care in Australia
Blum: Same thing. By the time I finished listening to her, I
realized this might be new for the States, but it wasn't
exactly new for the rest of the world. So that started me, and
I got an eight -week WHO [World Health Organization] fellowship
in 1962 for a tour of Europe that I designed. It took me to
places that were doing this sort of thing: amongst others,
France, where they had really carried it a long, long way
formally, to the point that some of their nurses were also
trained as social workers and some of the social workers were
also trained as nurses.
I went to a big eight-story building in Paris, where these
people were being trained, and part of that building—the top
floor—was a nursery for foundlings. The students, who were
getting the training in nursing and social work combined in a
total of three years, had to take care of these foundlings as
part of their training. So here they are all cooing and
working with these kids, and you realize right away that many
of the images that we have of babies are poorly conceived.
Here are the little babies sitting in slanting kind of little
troughs, facing one another-- just three, four, five, six months
old—really holding forth, you know.
Crawford: Just conversing!
Blum: And we supposedly know that babies don't do that, but nobody
ever got them to try. We say babies are this way until they're
a certain age. Well, any event, part of the training these
people got was to take care of babies because they hadn't yet
had their own families. Then when I went out in the field and
got to Orleans, they took care of me, showed me the district
offices, and I met the workers. I went with the health officer
to lunch— let me tell you, that was an affair— one of the
finest meals I've ever eaten— at the railroad station.
II
Blum: In this setting they had these multiskilled workers. One of
them was paid for by the railroads because there were a lot of
railroad workers in the area. One of them was paid for by
agriculture because there were a lot of farmers, and another
one was paid for by the health services, still another was paid
for by some other agency. They all worked out of the same
office, but the only difference was that if you were a railroad
worker, you went to the one that was paid for by the railroads.
194
The workers were hired and paid by the source of pay, but
each covered all the bases; they did the health, welfare, and
mental health kinds of things. That was kind of shocking
because the professions wouldn't let you get away with that in
the States. These workers knew one another's business, they
knew the community inside out, and they covered all the
services—not like that mess I told you about where innumerable
visiting workers from three separate agencies never knew
anything about the troubled little girl who was a victim of
incest, a well-kept secret by the social workers in probation.
I went from there back to Paris to see the national head of
the nursing-social worker operations. There was a lady in
charge — and she spoke English, thank god--and I said to her,
"Where are all the agreements that hold this together? Here's
workers from four separate organizations, all working side by
side, taking care of folks in Orleans." "Well," she said,
"that's very simple. There's really not much to that. Our
organizations just made up their mind to do it." She pulled
open a file drawer, picked up about three or four inches of
files and said, "These are all the agreements for France about
who does what." You know, in the United States, it would be a
thousand tons of agreements.
Crawford: Why?
Blum: Because every health department goes its own way. Every
welfare department in every city and every county does
likewise. In France a lot is settled at the national level. 1
couldn't get over it—these files covered all the agreements.
Well, if I'd never seen the workers, I'd say it was probably in
their minds, but when you see them at work--.
From there I went to Finland, and I saw comparable things.
It's more on a village-by-village basis in Finland, and less
well organized in Helsinki. From there, I went to England to
see the combined human services, which weren't combined very
well. I remember visiting a home in Oxford, and the lady had
to contend with about twenty home visitors, just like here.
She was complaining to me as an outside person about the
fantastic imposition of all the home visitors on her time. But
England had more services than the rest of the world has ever
seen. We never had services that good or inclusive, but one
can't inflict them all one by one through innumerable
specialized workers on one poor lady who has a couple of little
kids and no husband. They were driving her crazy. You've got
to report to a clinic at this hour, but at the same time you've
got to be over there for something else; and nobody's paying
any attention to the real needs of the person.
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Crawford:
Blum:
Crawford:
Blum:
This was just the opposite of our Rodeo situation, or the
French situation, where you were put in the hands of one person.
In Finland, they got away from that pretty much. A single
public health nurse would be in the community and in the
schools, and would be doing the social work and covering all
kinds of human needs. She worked as part of a team with the
local doctor who did part private fee-for-service practice and
part public health, caring for everyone in his area.
In Denmark, in those days, and this was in the sixties,
people didn't trust social workers, because the ethos of the
Danish people was that you ought to do these things for your
family, friends, and neighbors. They didn't want professionals
coming in to help a family because the people in the community
should help one another. The health workers were specialized
enough so that they were okay. Denmark had a very interesting
family practitioner and public health nurse team in every
little community. Social workers were a late arrival on the
scene, because people said, "Shouldn't we be doing this
ourselves?" As I learned--! spent quite a bit of time there-
one of the biggest threats you can make to a professional was
that "I'm going to commit suicide," which really was a threat
to the family and neighbors as well; it said, "Everybody's
failed me."
They do have a high suicide rate.
Yes, the highest in the world. And this was probably a way to
vent their hostility. They had no murders. When I was there
they could remember only one murder five years back on the
Copenhagen waterfront, but suicides—yes . This also was a
nasty threat for psychiatrists, even those who had been trained
in the U.S.; they got shaky about their professional competency
or caring when somebody threatened suicide. There are major
different cultural things that have to be taken into account;
quite fascinating.
You wrote up the visit.
Yes.1
I'm going to follow this set of concerns forward over
several decades because of the theme of multiservice care for
persons, families, and communities. In later years I got to
"'The Multipurpose Worker, A Family Specialist."
Public Health, 1966.
American Journal of
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Crawford:
Blum:
wandering around the world for other reasons and found many
different human services — and some beautiful examples of
combined services, well-coordinated teams, and multi-cross-
trained workers. Under the cross-training rubric there should
be a lot of educational effort put into creating multipurpose
human-service workers as a result of the economic pressures
posed by HMOs. Maybe it's going to start.
In Australia rather recently—in the 1980s — it turns out
that there were several physicians who had escaped from South
Africa, a family that had been involved in the world's really
pioneer community-oriented primary care (COPC) with the Zulus,
saying you can't provide health care just in the way you were
taught in medical school; it's got more to do with who the
people are than with who you are. You've got to pay attention
to religion, to customs, to the social, economic circumstances,
and to the community and the individual that results. It was
community- oriented primary care— it would take the community
into account. Who are these people? The key figure was Sidney
Kark. When South Africa became intolerable he went to Israel-
took his ideas there. He had two cousins who were family
practitioners also, and they went to Australia. One cousin was
Sidney Sax.
It turns out that in years gone by, Sidney Sax had been a
visitor here about the time we built our home. I took him home
for something or other, gave him some sherry, we sat and looked
at the view together. When I went to Australia for two or
three months, some fifteen years later, people hooked me up
with various people to visit, and he was one of them. When I
got to Canberra— the national capital—he really took over and
we went everywhere; he did everything for us. I finally said,
"I don't see why you should do this." He was the head of the
Institute of Health and Welfare. He said, "Well, you did it
for me fifteen years ago." [laughs]
And you had forgotten?
I'd forgotten. He said, "I remember sitting in your living
room"--then it commenced to come back to me— "sipping sherry
and looking at the beautiful world." Australia had had what
they called a Liberal government, meaning anything but a
liberal government, for years and years and years. Then Labour
came in in the early 1970s—a Labour government --and they came
in on a promise of universal health care, which Britain already
had, you see. It was another world- -not like here. Sidney Sax
had been picked to be the Minister of Health and Welfare [by
Labour] , but they figured that he would be shadow minister in
the British tradition because they could never win the
197
election. Well, they won the election, and the first night
they were sitting there in Canberra—they're in.
The new prime minister said, "We ran on a platform of
health care for everybody, Sidney. When can you have me a plan
for the works?" He replied, "In six months, nine months, we'll
have it all laid out—eighteen months." And the prime minister
looked at him and said, "Eighteen hours . I want it tomorrow."
And they did it. You don't have to work out all the goddamned
details.
Part of what they did was to offer funding for multihuman
service units in every state in Australia; multihuman service
units including health, as well as universal health care.
There was money for it. Every medical school in Australia was
forced to have a unit of social health planning, and Sidney
just sat down and cooked it all up essentially overnight. He'd
had this wonderful background in South Africa, thinking about
people as whole persons who were a part of a community.
Crawford: Where it had worked.
Blum: Where it had worked—with very disadvantaged people, to be
sure. So every Australian medical school does have a social
health department to this day.
Crawford: It's a good system?
Blum: For medical school? Yes, it's imperative to know something
about human beings and the relationships between them and their
society.
Crawford: Does it work out in the communities?
Blum: The Labour government only lasted a couple of years because
they didn't carry the upper house- -the equivalent of the
British Lords. And that house had, in Australia, the authority
to sign off on money bills, so the lower house, which Labour
carried, put all these programs into place, and the upper house
wouldn't fund them.
After a couple of years, government debts were mounting—
the money wasn't being voted, you see. So the conservative
people in the government appealed to the Governor General of
Australia, appointed by Her Majesty, the Queen of England,
saying, "You've got to do something about this." This business
of being a Commonwealth country is not without its interesting
angles. And the Labour government was turned aside; the
government was handed back to the Conservatives. If you keep
198
current on Australian politics you will hear about this episode
as part of the reason Australia will probably be leaving the
Commonwealth soon.
But overall it was a tremendous new program. To be sure,
many pieces of it fell apart, but I was there ten years later
and there were still many of these community health centers.
Some of them weren't called that, but they were multiservice
centers providing for all kinds of services in one place with
an integrated team of human service specialists.
One of them was a fantastic operation in Adelaide- -until
you see it you can't believe it--in a newer part of the city, a
working man's community with a lot of poor people living in
government housing; a lot of women and kids with no husbands; a
huge, beautiful new pair of schools. Tied to the schools are
the service arms of the community. So here's a library, but
it's also the health library, and welfare library, and the
nutrition service. There's a swimming pool; there's a gym;
there's all this available to the community. It's not just a
school. There's a physician, nurses, social workers working in
this center.
Then I went to one further out from Adelaide , known as
Friendly Farms. I met the doctor who started it--he'd
graduated when the Labour government came in. The community
had been built up to house the workers at a huge new auto
factory at the periphery of Adelaide. It was not very
successful—big layoffs ultimately—and a lot of poor people.
This doctor was fresh out of school with a tiny office,
about eight by eight. He came there while business was still
booming. What he discovered was that people kept coming for
care, but they really were mostly disoriented. They were
newcomers to Adelaide—they 'd come from other parts to get
jobs — and they were just having babies, and new families, and
were having a hard time getting their lives together.
Every night he had classes, talking with people who had
similar problems, and this is how his practice started.
Instead of giving them more pills and more vitamins, he was
looking at the social, human, economic, health side of the
whole thing. He was a remarkable physician, and his practice
went like wildfire.
The next thing you know, he had a building, and then he
hired a social worker—and this is a doctor, you see, and he's
not going to get money out of it because it was all paid for.
It's not the usual use of medical social work as we think of it
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Crawford:
Blum:
in the U.S.A., which is to get dollars out of people's pockets
to pay for services, which is what happened in the hospital
business, or get them out when it's time. This was the real
thing to help people. He had mental health workers; he had
public health nurses, and this is a private practitioner. This
was not government. True, government was underwriting all the
human services, but he was putting them together so that a
patient's needs were understood and met, no pills for worry, no
surgery for worry-produced bowel distress.
We visited this center. It was a big, beautiful plant. We
got there, sat around and chatted with him, and he brought in
his head administrator, who used to be the superintendent of
schools — a fairly young man. Much of his training was in
bringing people together, and they were teaching one another.
This man had taken over as the doctor's majordomo, his
administrator. But when we were there, the auto industry was
dying in Australia and, at this time, he said that it was very
interesting that they still had all these classes, and patients
groups still met with the doctor, but they had a whole
different set of problems now. The kids were growing up, and
some of them were starting to go away to school; some of the
families were breaking apart, and there was a whole series of
new social phenomena that were making these people want to see
the doctor, and they were now dealing with new social
situations, but still on the basis of working things out
together. This was covering the bases. Fabulous!
When did you first see this?
That was late, already, fifteen years after Rodeo. Of course,
in Canada you'd see things like that. In '77, I had a
fantastic year--I took a sabbatical. Went across Canada seeing
multiservice clinics all the way from Vancouver Island, where
they had some wonderful clinics with hundreds of volunteers
right near the Empress Hotel in Victoria. It's in an older
neighborhood, a nice neighborhood, but there are a lot of old
people, a lot of problems. They had this joint clinic with all
kinds of services and a couple hundred volunteers and were
servicing all kinds of people. Most of the servicing is not
straight health care such as would be reflected here in terms
of pills, and surgery, and doctors visits. There it was
concern for loneliness, for some Alzheimer's, and some this,
and some that. Also, a lot of hippies had moved into this
neighborhood as it was getting old and less expensive, and they
had very different demands. They had drug problems, growing-up
problems, which, again, are not medical in the usual sense.
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We got to see it all operate, and to see how apartment
house people worked it out with the clinic. They would call on
the clinic if they had problems of any kind. In return, the
clinic would notify apartment house managers and say you've got
somebody there that you've got keep an eye on. It was just a
marvelous cooperative venture of a health clinic with all
elements of the community. They had a large group of people
who by means of a health clinic were concerned with other
people's problems.
Studying the diverse approaches taken in Australia to
provide health care, much of it started under the brief tenure
of the Labour government, brought us to Alice Springs. It's at
the very center of Australia and home to a very large
Aboriginal population. As in much of Australia, the
Aboriginals were just sort of tolerated here, a kind of
subclass, enjoying more nearly the status of our American
Indians where there are significant numbers of them, rather
than the more formal disadvantaging offered our black people.
Their culture is also more nature- and land-based, with no
corporate or individual ownership of land, farms, not unlike
our Indians. In fact, when we were there we had just followed
a Navajo delegation interested in learning about this
particular Aboriginal health center's activities.
It had been founded over a half dozen years earlier by a
professor of medicine from the University of British Columbia.
The doctor currently in charge was a young Australian with half
a dozen kids who very much wanted a public health degree from
UC Berkeley, but couldn't afford to get away.
On the day of our visit, the founding doctor, who had gone
on to create a medical school in New Guinea, had come back to
see how things were doing. We sat together for most of a day
and heard a wonderful story.
The Aboriginals with their Canadian doctor had gotten a
grant from the national Labour government to start a clinic and
had gotten involved in doing all the things that they thought
were good for their health. After getting the doctor and a
nurse they had branched out and set up a small bank of their
own because they didn't trust the big ones, probably wisely so.
This was done because as they came in from their station jobs,
they soon wasted or drank up all their money because they had
no place to keep it and no use for it.
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Another early step was the creation of a pharmacy in the
clinic so they could get what was prescribed without getting
robbed or insulted.
Another step of a major sort was their creation of a radio
station, which soon served many purposes. It taught English to
the huge Aboriginal population within its thousand-mile radius,
the heart of Australia's Aboriginal population. By popular
request it branched out into educating about cattle raising for
cattle stations and their workers, which were generally
Aboriginals who were becoming stockmen. The station did
cultural things, news and whatever Aboriginals wanted.
In one of our excursions we visited and ate at a huge
cattle station, were cared for by Anglos but saw many
Aboriginals about. It turned out that this and an adjacent
station were now owned by the Aboriginals who operated the
health center and were learning how to run it from the Anglos,
as well as raising cattle.
With their savings they bought the ranches from Anglos who
could no longer make a go of it with their jeeps and airplanes.
The "Abos," as they are usually called, lived with their stock,
moving them for food and water as they had always done for
themselves. They were earning money and buying back their
land, and learning about ownership, which had never been part
of their lives or culture.
The health center brought in a lawyer to look after the
legal needs. Arrests in Alice Springs were primarily an Abo
phenomenon even though these people were a minority.
Before a year was out, their arrests were less than 10
percent of the total because the lawyer looked into each arrest
and the fun was over for the Alice Springs police force.
The Abos had had houses created for them, simple affairs,
which they had no intention of occupying, as they preferred
living outside in a simple shade-providing structure. But
their kids were being disadvantaged by their non-dwelling
lifestyle. The health center took charge of two schools which
served primarily Abos, arranged for showers, laundry, meals,
health care, and a couple of school buses to facilitate
covering their needs and education.
The health center also serviced anyone, as well as being
free for Abos. A little sign at reception said, "Please pay
what you can." There were backpacks scattered around as this
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was a stop for mostly college students from the States or
Europe.
As we were there, an Aboriginal man came in for his follow-
up visit. He had been hit by a car a few weeks preceding and
had been taken to emergency at the adjacent, beautiful, new
community hospital. He spoke no English, was cursorily
examined, and sent away.
Fortunately, he stopped by the clinic, where they saw that
he was leaking cerebro-spinal fluid from one ear, an absolutely
diagnostic sign of a skull fracture and a dangerous one as it
meant there was an open passageway for infection to the brain.
The doctor had picked up the phone, gotten the M.D. in charge,
and the patient was promptly admitted. This was their special
duty, keeping an eye on the quality of care at the community
hospital, and forcing it to change its practices for the
better.
Some health center, was all I could think. When I asked
the founding and the current doctors what was their purpose in
making this the kind of a health center that was relevant to
the lives of the Abos, they immediately chimed in, "We want to
give them a breathing spell, to decide do they want to join in
with the Euro lifestyle, and if so, we will help them come in
with a more nearly equal chance of succeeding, or do they want
to go back to their walkabout, communal-pastoral-desert
lifestyle? We'll help them in whatever they choose. The
health center is the logical place from which to help the
Aboriginals navigate the never-ending social changes which
determine their well being."
Marian and I had to go to the center of Australia to hear
this, spoken as it never would be anywhere else, at a health
center .
Birth Control Programs and Governor Pat Brown
Blum: There were other interesting things that happened in Contra
Costa. Did we ever go through birth control! When I first
came to the Contra Costa health department, maternal and child
health was a big thing. One of the things that you had to
offer if you were going to be serious about maternal health was
birth control; some women shouldn't be having a child at one or
another time in their lives.
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But no government agency west of the Mississippi or north
of the Ohio ever did birth control, apparently. It was done in
the South—and for a good enough reason—by nice white folks
who meant well by serving nice black folks. However, it was an
intolerable idea out here, particularly wherever Catholicism
was a significant force, or thought to be.
We thought , There ' s no use running an MCH program if we
can't do the most important things, which for some women,
certainly as far as sparing their life is concerned, just might
be birth control. Big families that are in a disaster mode
can't keep adding babies every year just casually.
We sat down and worked it through, and decided that, yes,
we would undertake to provide birth control as part of the
maternal and child health program. We created what we called a
"white paper." Dr. Yoshiye Togasaki did the homework on that.
As I've said, she was my classmate from Harvard, a pediatrician
now full time in the health department. She developed a white
paper which was based on some very ethical principles.
For example, if you knew that somebody needed this service
and the only thing between you and providing it was doing
it — there were no laws against it, just an unwritten political
law that government shouldn't be involved. But if you're
really playing the doctor and advising a woman about her health
and her survival, maybe you'd better worry about the things
that were relevant to her survival, such as birth control.
Then our white paper went further to point out that any
other woman who had money and didn't depend on the health
department for services could and would get such services
privately, so there was nothing terribly immoral about it. It
was just that if you had money you could have this necessary
service, and if you didn't, you couldn't because you depended
on the health department. The white paper took the moral stand
that poverty should not be the determinant of risking death or
of ensuring life.
We hauled it around to the California Conference of Local
Health Officers, and got approval with the exception of one vote
--the Catholic health officer of Santa Barbara County, which had
a big Catholic population even in those days. It would probably
be the early sixties when we finally brought it off.
The Conference of Local Health Officers— a legally
constituted entity— adopted the white paper as its policy. But
there wasn't anybody going to do anything about it. Then we
passed it on to the California State Board of Health. In those
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pre-Reagan days, early to mid-sixties, it was a very powerful,
independent body, like the Regents are supposed to be; they
were appointed by the governor and the legislature. It was
really a state board of health. It was among the best of the
state health boards and really had a lot of power. There were
always powerful representatives on it from the California
Medical Association. To be sure, they didn't always see eye to
eye with non-physicians about public health measures, but
generally speaking they did do what was best for Calif ornians.
I remember the last chairman of the board was Roger
Eggeberg, who was dean of the medical school at USC and
subsequently chief of medical services for Douglas MacArthur.
He was a wonderful guy, a huge man—huge in spirit—a good
mind. The state board adopted our white paper as California
public health policy. However, it didn't motivate anybody
except us. We got Planned Parenthood to set up our first
clinics for us because we had never done a birth control or
family planning clinic ourselves.
Crawford: What was the format of the clinic?
Blum: Oh, it was a straight health department clinic. Public health
nurses were the mainstay of the health department; they
referred people into various clinics: ours, others, even over
to the hospitals in Berkeley or Oakland, even San Francisco or
wherever, if necessary. In our clinics we hired physicians to
do the medical work, the nurses and volunteers assisted and
educated the patients at each clinic session.
Crawford: Was it an aggressive program?
Blum: I would say it was. If a public health nurse thought that one
of the people she was assisting needed family planning, she
would refer her to one of our clinics. Planned Parenthood
provided staff from their Oakland office to come and train our
nurses in our own clinics. Some of our people may have known
all about the procedures, but we hadn't done it ourselves, it
was not something that we regarded ourselves as very expert at.
Just the other day I was with one of the people who remembered
how she'd come to help us in Contra Costa County.
As helpful as they were about helping us set up, Planned
Parenthood said, "Why don't we come in and do all the clinics
for you?" I really could see the end of the program in a hurry
because if they offered to do it, then the county would never
do it. But we knew that if they had one clinic in Oakland,
they weren't going to have much more in Contra Costa; they were
going to meet a tiny fraction of the needs, and keep us from
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doing the job. Yet it would give our board of supervisors an
excuse to avoid taking on a hot potato, but what a lousy excuse
it would be. We ultimately had about twenty clinics monthly in
different parts of the county.
Crawford: And why would that be in Planned Parenthood 's best interest?
Blum: There was nothing evil about their intentions. It was just
part of the "good work," as seen from their standpoint. From
our standpoint, it was just a way of ultimately keeping us from
doing the size of a job that was needed in our county.
They finally quieted down and taught us how to do what they
knew very well. They created a very superb service. One of
their board got us a grant to get started from an unnamed,
numbered bank account in Switzerland. You might say that we
were sent a gift of birth control services.
Crawford: Who was that?
Blum: I don't know who created it. I would guess it was a woman. I
think it was a Dr. Smith, associated with Children's Hospital
for years and years, who worked for nothing down there, and
gave her whole life to kids. I don't know that it was she; I
have a feeling that it was.
In any event, we had some money to get a few extra things --
whatever was needed. We got training materials and patient
education materials and we started. The first clinic we
started was way out in the Brentwood area, in the eastern
county, which was almost entirely rural in those days.
Crawford: Largely Hispanic?
Blum: Not remarkably Hispanic. There were people there from Arabia,
mostly a lot of American agricultural migrants settling out.
It was just all kinds of poor people. These were people still
settling out from the Dust Bowl and working in agriculture.
We got our referrals, initially, mostly from a Catholic
priest—which we thought was a good idea. He was quite pleased
to send us people that he thought needed the services. The
three doctors who serviced our clinic were wonderful. One of
them was an ex-Catholic, one of them was a practicing Catholic,
and one of them was a Jew; they were partners. They were
superb people. One or two of them are still left in the
community on school boards and city councils. They do
everything. They're people-oriented. They were family
practitioners, and they had one of these Sears & Roebuck
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Crawford :
Blum:
Crawford:
Blum:
offices. Sears & Roebuck had, at one time, put out loan money
for offices for doctors who would go into truly rural, unserved
areas .
We gave them the option—they could run our clinic in their
office or we would set up a clinic. They thought it would be
better in their office. It would be simpler for them. They
had their routine, their people, and everything.
They were also doing well-child clinics for us. They were
true general practitioners. In fact, they ultimately took one
of the students from the first class here in the medical school
at UCB who had to do a month of field work of that sort as the
students started in the first year of our medical school.
I remember that their office billed us for their services,
but they had to do it on county forms, and I remember them
asking, "Couldn't we skip the county forms? Why can't we bill
you on our forms? You're setting the stage for our staff to be
snooty about these customers who come with county forms, while
our private patients just come in. We don't need to set the
stage for discrimination in our office." This was very
atypical for physicians in those days, and we were proud of
them for their sensitivity.
To be sensitive in that way?
Yes--their attitude of, "Let's not add any needless problems
for these folks; these folks have got their share of problems."
I thought that was marvelous.
So, we had a Catholic referral source — a priest of a local
parish— and we had these docs, two of whom were Catholic. It
was really a nice operation. It was made clear by us to our
nurses that if they didn't want to work in a birth control
clinic, they didn't have to. There were certain of the nurses
for whom that was not a happy prospect.
Somewhere about this time, a man by the name of Weingand,
who was the state senator from Santa Barbara County, heard
about this, and he had introduced a bill— this was in Pat
Brown's time- -which said that health departments had to do
birth control. Weingand was very interesting, and a wealthy
man. He and Ronald Colman--do you remember that name?
Yes, I do.
A movie star— were partners in Rancho San Ysidro, just outside
of Santa Barbara.
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Crawford: San Ysidro?
Blum: San Ysidro. That's the one that John F. Kennedy and Jacqueline
had their honeymoon in.
Well, he introduced the bill. We weren't totally secretive
about what we were doing—we just didn't advertise it--but
first thing I know, Weingand asked if I would please come up
and testify at a legislative hearing in Sacramento.
We got to the hearing, and everybody was there: cameras,
reporters, everybody. There was a Catholic legislator on this
committee and he didn't want the trouble of having to vote yes
or no, so he started out on a clever tack. He said, "Doctor,
is there anything in the California state law that you are
aware of that would prevent a health department from offering
birth control services?" Well, he certainly had me in an
interesting spot, since we were doing it already on a huge
scale all over the county. I said no, of course not.
Crawford: Was the nature of this investigative?
Blum: No, no, this was not an investigation, this was a hearing on
Weingand 's bill requiring all health departments to provide
birth control services.
Crawford:
Blum:
He repeated himself, and I said, "No, absolutely not. We
know that's the case. We investigated it totally." So, this
committee member turns to the committee and says, "Mr.
Chairman, I move we table this bill. There's no point in it.
There's absolutely no reason we have to deal with this bill
since health departments can offer birth control services now."
Everybody on the committee was so glad to get rid of it, they
tabled it. That was the end of the bill.
That was in the morning in Sacramento, and at noon, the
Contra Costa County Health and Welfare Federation was holding
its annual meeting of about 450 guests and members in Concord
at the Sheraton. I was president of that organization, and our
guest speaker was the head of health and welfare for Pat Brown.
Winslow Christian was a lawyer, and became a well known judge
afterwards. He was a Mormon, and a very lovely man. He
helicoptered down, and I drove like mad to get back in time.
Luckily it was in Sacramento.
I got to Concord, and didn't know what else the future held
because the Sacramento hearings were the first news to most
people in Contra Costa that we ran birth control clinics.
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Crawford: Well, you weren't trying to keep them quiet?
Blum: No, but we weren't making an issue of it, either.
Crawford: Did you anticipate some trouble?
Blum: Oh, we anticipated plenty of trouble, and that was the reason
for the white paper, and getting it adopted by the Conference
of Local Health Officers and then by the State Board of Health.
We sat down to our meal, and Winslow Christian said,
"Doctor, do you have any feelings about what 1 talk about?" I
said, "Oh, no. We asked you to bring what you at the state
level thought was the most pressing business here." There were
some members of the press there too, of course. This was a big
gathering of all the elite Contra Costa County folks. He said,
"Well, the governor and I talked about this, and we are going
to present this statement about birth control and family
planning." And it was our white paper—the one that we had
created in Contra Costa several years before. He said, "This
is the governor's official position; this is my position; and
this is where we go from here. This is service we expect every
health department to offer. We don't need any new laws."
As an aside, people probably don't remember, but Pat Brown
was always a good Catholic. Pat Brown even got remarried in
the church just a couple of years before this happened, because
he'd had a civil marriage originally. So you know that he was
a serious Catholic and making a point of it. Here's his
minister—the Secretary of Health and Welfare— who" s a Mormon
and supposedly more apt to talk about procreation than how to
avoid it.
When I got back to my office about two-thirty, every
newspaper in the country wanted to talk to me. This was really
a big deal. I called the Richmond Independent first because
that was our lousy, local, little paper— and it was a lousy
little paper. The reporter whose call I was returning was a
fellow by the name of Archinal. He was a mean little cuss, and
I'm sure if he's still alive, he hasn't improved any. He said,
"Doctor, did you clear this with the Archdiocese in Oakland?"
I responded that I'd never thought of that because I'd never
worked for the Archdiocese, I worked for the people of Contra
Costa County. He was looking for some vulnerable point.
Well, at that point the Richmond Independent was already
out with foot-high headlines: "Health Officer Admits Operating
Birth Control Clinics." So you can see that we weren't wrong
in anticipating trouble. I said, "Why don't you clear it with
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Crawford:
Blum:
Crawford;
Blum:
the Archdiocese and find out what they have to say? It would
be interesting." So he did.
This was national news?
Yes, and especially the Chronicle, the Examiner, the Tribune- -
the big local papers. We got visibility, to put it mildly, and
here's this Richmond Independent trashing us.
The next day there was a full page in the Richmond
Independent on what the Archdiocese had to say about it. We
read that page, and it listed all the sins that we were
committing. Well, I think we knew them just as well as the
Archbishop because we had studied the ethics book from the St.
Louis Catholic University Medical School, and much of that book
was on birth control. We had studied it before we wrote the
white paper and countered all the issues that they raised, most
of which were irrelevant from my standpoint of social justice.
The Archbishop of the Oakland Archdiocese ended up saying, "The
Archdiocese plans no action at this time," and that was the end
of it.
Before many days were over, health departments all over the
country were in the business. It wasn't bad, you see, but
there still were a few states that had laws against
disseminating birth control information.
Can we endorse programs abroad at this point?
Oh, we spent more money on that than we ever did internally.
We had been doing this work all over the world, but we had
different eras of being for or against it, depending on who was
president and who's singing the loudest. In this country the
result to allow sale of birth control devices started in Boston
and New England years before, when you couldn't even buy
contraceptive materials in drugstores. That was a real late
development in this country—it was mid-century. Although the
ban on contraceptives was taken off the books in most states
before 1960, it just wasn't offered in public agencies. If it
was, it was done surreptitiously. So we broke that taboo which
only discriminated against the poor.
Then I went on the circuit, I was invited here, and invited
there to talk about it. One of the first places that I was
invited to was Santa Barbara because Santa Barbara, as well as
being a strong Catholic community, is also a very strong New
England-Protestant community with summer homes of very, very
wealthy New Englanders. There is a regular Protestant social
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roster down there in Santa Barbara, and some of these people
were very pro-family planning.
Crawford: That's interesting, because it's such a conservative place.
Blum: Oh, yes, but not about birth control for the Protestants. The
real wealth in that community is the Eastern wealth, old East
Coast wealth, Protestant wealth.
So I was down there first thing. We stayed in that San
Ysidro Ranch as a guest of Senator Weingand and we were treated
like royalty. The first night we were there, we went to their
famous restaurant with big adobe walls—it was historically
used to keep the lemons cool when they picked them on the
rancho; but now it's a fine restaurant.
It was where he invited us, and we had a beautiful meal.
He said, "I should tell you something about what you've been
through." Here I thought I 'd been through it and we had
figured all this out. Well, it seems that he and Pat Brown and
his Health and Welfare director had dinner the night before
those hearings. So I wasn't really in the middle of putting
all this together at all, I was just a tool. [laughter] They
had decided that the thing to do was to use these hearings to
get an airing of the issue, but irrespective of how they turned
out, they knew that that new law wasn't required. Weingand was
just doing it to force the issue. Then, since the Secretary of
Health and Welfare was speaking in Contra Costa on the same
day, he would trot out our policy, just get it all over at one
big bash. Moreover, the inconclusive hearings at Sacramento
took the edge off the issue while the governor's statement at
the lunch in Contra Costa County got the policy out with a
minimum of fanfare.
Crawford: This was all rather elaborately orchestrated, then?
Blum: Elaborate, and I'm the thing being orchestrated. [laughter]
My wife and I sit, listening to this, and you don't know
whether to feel foolish or smart, because you're very clearly
just a pawn, but a useful one by being the first in the
business when the risk was still high.
Crawford: Well, they probably chose the right man, then.
Blum: Yes. I knew Pat Brown fairly well and it was he who appointed
me to several statewide commissions before that. I hadn't done
many political things, so I wasn't startled, you know, but for
a Catholic to take that kind of a risk and to use a Mormon to
do it is really so damn subtle. They really killed the
211
opposition cold, but took the chance of killing themselves,
Laudable governance at the least.
Crawford: Well, he didn't worry about that,
admirable.
I think that ' s rather
Blum: I loved Pat Brown, he was all right. But the net result of all
of that, really, I haven't yet told you. Everything subsided,
and my board of supervisors is sitting there, aghast. Four of
them are Catholics, the county manager is a Catholic, and the
fifth board of supervisors member is in a Catholic district,
but isn't a Catholic. So he's the most vulnerable of all. How
do you like that for a potentially stacked deck?
The next budget hearing was coming up, and this time in the
budget we had lines showing what the stuff was for. In the
past, we really lumped like things together, e.g., drugs,
instruments, personnel hours—we didn't specify everything by
the purpose it was to serve. This time they had told us we had
to specify. That was the game. So if anything about birth
control would show up as such, they could knock it out with a
scratch of a pencil.
I went to the finance committee meeting of the board, with
the Catholic administrator who had only two children and didn't
mean to have any more. In fact, none of the board members did
either. [laughs] But business is business. They said to me,
"Doctor, you have to knock this out — all the birth control
items." And I said, "Look, you're the ones that asked for the
itemization." They said, "Yes, but we just can't have this in
the budget." I said, "It seems to me that you had better not
knock this out because I have a feeling that at least a
thousand people will descend on the boardroom the day after you
knock it out. You'll be lucky to ever go home. It might be
five thousand people." These are the realities, and if they
didn't understand these things, I thought I'd better explain
them.
They said, "Oh, gosh, Doctor, we treat you real good, don't
we?" It's a whole new line of reasoning. [laughs] I said,
"Yes, you're very fair, and I have nothing to complain about
really. I can't complain at all. You're a good board." Then
they said, "We're very generous, really, with the health
department, aren't we?" I said, "Well, I guess you could say
that. You don't cut stuff out willy-nilly, and so on, yes. We
don't ask you for much fancy stuff, but we surely ask you for
things all the time." The budget was getting big, in spite of
our attempts to hold it down. They said, "Well, let's cut
these birth control items out, and then you do what you damn
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well please about which categories you dip into to do your
birth control work."
Crawford: Call it something else?
Blum: Don't call it anything, just cut these labeled items out,
they'll disappear, and our budget could take it by skimping
here and there. It wasn't that much--maybe twenty-five
thousand dollars.
Crawford: Were you still operating with the Swiss money?
Blum: No, that was just chicken feed, long since gone.
Crawford: That had been used to set up the clinics?
Blum: Yes, that was just to get started. I think we may have paid
that to Planned Parenthood because they had to pay the salary
of their people to come and work with us. So I said to the
board, "This time we'll agree to knock it out, but don't think
it's going to be knocked out again." So the next year, there
it was — all the birth control items, and nobody said a word.
It was past history.
Crawford: It was a line that clearly defined it as birth control?
Blum: Oh, yes, birth control supplies.
Crawford: Did it ever stop being sensitive?
Blum: Yes, that was the end of it, really, the end of it.
Crawford: It was publicly approved by even the church, tacitly?
Blum: Tacitly, the church hadn't said, "God bless you," but, yes,
that was all over. I'll come back to the payoff for me when I
get into our move to Berkeley.
Elizabeth Jolly and the Crippled Children's Program
Blum: In the 1960s the health department hired Elizabeth Jolly, a
young M.D. with a degree in public health, to run its Crippled
Children's Program which provided specialist medical care and
therapy services for children with disabilities. It enabled
people to get what were very expensive services irrespective of
what they could afford. The position involved arranging for
213
and then approving medical, surgical, and therapist care.
Doctors were a major source of referrals, and our own doctors
and the public health nurses found cases in the course of
visiting homes, new arrivals, and PTA and other school-based
health activities.
This was obviously a very expensive program, but it rebuilt
hips, overcame disfiguring head and limb and internal organ
abnormalities. It also provided ongoing clinics staffed by the
best Bay Area specialists for kids with heart and other long-
term serious diseases and congenital defects. Dr. Jolly
inherited the program from a fine public health-trained
pediatrician who remained full-time with Maternal and Child
Health, since the child population was literally doubling in a
decade. At the end of her first week in the Crippled
Children's Services (CCS), she made some interesting
observations. She asked me to come by and look at the caseload
with her. She took the file card for each case (this was
decades before computers) and put them in three stacks. One
was about four inches high, one about two, and the last one
about one inch high. She explained that these were sorted by
whether the case was almost certainly genetic in origin, likely
but not certainly genetic, and clearly not genetic, such as
trauma, burns, poisoning. She asked me to guess which stack
was which. I only remember that I was totally wrong and that
the big stack was genetic and the smallest one was not genetic.
On the genetic stack she then showed me several families
that had more than one child with the same condition, some
truly grim, such as hereditary young male adult blindness.
This set us off on quite an intellectual spin, particularly
since we were already providing birth control advice and
services. Some of the families with multiple cases were
tragic. One mother contemplated suicide because of her
inadvertent role in transmitting a male-only blindness which
her father, a physician, developed after she was born. Her
oldest son just got the diagnosis, and her two younger boys
also faced early blindness.
Dr. Jolly had been interested in things genetic, as so many
people are, but this soon became her life's work, not just a
concern. She found a keen human geneticist, Curt Stern, at UCB
who had not been involved in doing anything about it other than
studying the various diseases caused by genetic disorders, and
the nature and extent of their hereditary transmission. She
took him the records of her families and they worked out what
options might be offered in each case. In some, basic birth
control was the answer, and applicable along the family tree.
214
In others, this was irrelevant or too late. But advice to
involved persons and potentially involved family members could
be life-saving where prompt medical diagnosis and care could
hold the disease, or where avoidance of certain exposures could
minimize or delay damage from inherited disease.
Thus began the first formal genetic counseling program that
any of us had ever heard of. In getting grounded we used a
family tree approach to get necessary information for the
counseling and to begin the search for other persons who might
be hereditarily involved in order to find them long before
there would be any evidence of the familial disease. In some
cases it meant watchful waiting; in others, the need to prevent
further offspring; in others, blood testing.
Nurses helped the involved families to fill out the tree,
who was on it, and what had happened to them to date. Families
loved this, contacted long-abandoned relatives, and got
information that varied from critical firm diagnoses to wild
guesses. Sometimes it would be a year or more later that a
family would call in to say that so-and-so, who was related in
certain ways, had developed a clear-cut diagnosis that had
genetic implications or had confirmed the presence of suspected
familial disease.
Looking at a family history was a favorite way for our
public health nurses to get acquainted with a family even when
the introduction to the family had no relationship to genetic
concerns. The nurses asked for the freedom to use this mode of
introducing themselves and many did so for any but the most
inconsequential family contacts.
Someone heard about this activity, I suspect from the
papers we published,1 and we soon made the newspapers. We
started getting family trees from families in other parts of
the U.S. and even from other countries, with requests for
advice about one or another aspect of a problem. Much of it,
of course, was about what to expect from having children under
various disease-shadowed circumstances.
'Jolly, E., H.L. Blum, G. Keyes, and G. Smith. "Experience of Public
Health Nurses in Obtaining Family Pedigrees." Public Health Reports 80:1,
41-46, January 1965. Jolly, E. and H.L. Blum. "Genetic Counseling—A
Health Department Service to Physicians." California Medicine 103:5, 330-
333, November 1965. Jolly, E. and H.L. Blum. "The Role of Public Health
in Genetic Counseling." American Journal of Public Health 55:2, 186-190,
February 1966.
215
When I came to UCB I brought Betty Jolly with me, and she
also obtained a nontenured faculty slot to teach public health
genetics, and continue her research on genetic diseases,
transmission, and genetic counseling. These were the first
courses on genetics at the UCB School of Public Health.
One morning Dr. Jolly awoke with a painful abdomen, and in
a few days was diagnosed as having far advanced gastric
carcinoma and was dead in a year. She was not only a handsome
woman but one with a lovely personality, had a husband with
comparable qualities, and two lovely teenaged daughters. She
had a youngish mother and a physician sister who was a county
health officer in California.
When it came time to acknowledge her life and death, the
family descended on me to say what had to be said about her
life and her accomplishments at a family-only ceremony. I had
never undertaken such a task, knew her family hardly at all,
and tried to avoid it. But her family insisted that I
undoubtedly knew more about her work life than anyone else and
that was what they knew so little about, and what they wanted
to know more about .
I started out, broke down, had plenty of company, started
again, we broke down again, and that's pretty much how it went
for two hours when it suddenly seemed that we had done the job
and it was time to say goodbye to Betty and to one another. We
all hugged and parted.
Training Peace Corps Volunteers: 1964 f#
Crawford:
Blum:
Crawford;
Blum:
There are some consultancies in the 1960s,
did Peace Corps work in '64?
For example, you
Oh, that was just a small thing, but again, really reaffirming
my notions about what we were talking about. We were training
Peace Corps workers in the Contra Costa County Health
Department in some of the basics of sanitation.
To go out into the field?
Go out into the world, you know, a world with nothing. We had
our own little disaster manual—we'd give this to them, and
explain how to clean oil tanks, purify water, protect food, how
to do this, how to do that. Chances were they would never get
the necessary modern equipment, but we had prepared different
216
simple methods of doing all sorts of health-related tasks, even
tables about which kinds of drugs to use for what indications
if you were not a doctor. It was all do-able, workable; we
created this for disaster preparedness, and had a good time
doing it. Even a manual on toxics—the first one, I guess
anywhere. It was nice to have someone to use it on, as we
never had a disaster of the dimension that Peace Corps workers
were going to face routinely.
Crawford: In Contra Costa?
Blum: Yes, we had prepared it for an ultimate disaster in Contra
Costa--in the U.S.A., or anywhere else. The toxics manual was
used at UCSF. The Peace Corps people were going to areas that
were permanent disasters, by and large. So maybe they would
use it; we trained them how to protect or clean things, how to
fight various problems.
Crawford: How did you get this association?
Blum: I don't know, I just volunteered, I guess.
Crawford: In other words, the Peace Corps might have written health
departments and asked for this training?
Blum: Yes. However, I remember that Len Duhl was Sargent Shriver's
health advisor— Shriver, the head of the Peace Corps — and Len
was very close to the Kennedys. He might have had something to
do with our involvement .
The Peace Corps worked for two-year terms, typically— and
by the third year, all the Peace Corps people who had returned
after their two years were invited by Shriver to the State
Department for a big week. They weren't very fond of Shriver,
which was kind of funny because he kept the CIA out of their
ranks and really seemed to be quite involved in their well-
being. I guess it was a generic distrust of political people
by folks who were prepared to put their lives at risk.
II
Blum: The Peace Corps also got one hundred people like me to come and
sit down with these folks for a couple of days and consider how
these returnees, who were from every walk of life, could put
what they had learned overseas to use at home. A marvelous
program. I loved what I saw because here were people of all
races throwing their arms around one another. They hadn't seen
one other since Africa, Asia, wherever; and here they are just
obviously really entranced to see one another.
217
Then we sat down, and the advisors kept rotating to groups
of twenty returnees. Every two hours or so I'd go to another
group. Their theme was, "What can we do here with what we
learned overseas?" It was going to be damned little, but many
of them intended to try, and some ultimately went back overseas
because our ways of doing things were pretty entrenched and not
necessarily burdened with the human touch.
The miscue of the first half really was the opening address
by Shriver, who was on the edge of getting the business from
the attendees. But then Earl Warren spoke for an hour, and
they just went crazy. He was great. Then Hubert Humphrey
spoke, and he spoke too much. I remember that he didn't play
the hero, and ultimately he came across well. He said, "If you
don't like what you see in Washington, remember that's no more
than a mirror image of you folks back home. If you didn't want
what you don't like, you wouldn't have it." That was pretty
insightful.
Then Sister Jacqueline from Webster College — the one I
spoke of a while ago—gave the closing address. She happened
to be a very beautiful woman. She was still in her habit, and
I had ridden to this affair in a taxi with her from the hotel
where we were staying, at the Dupont Circle. I had always been
a bit patronizing, I think, to nuns, and there she was, in her
habit. I asked her something about Webster Falls, which she
had made very famous as a little Catholic university. As a
matter of fact, she started to explain to those of us in the
cab that she was free to leave now; she had done her job there.
She had left a new, non-Catholic board of regents in charge of
this Catholic school where she had been the boss. Webster
College now had a board of regents— and the chairman was also
the chairman of MIT: I can't remember whom- -a nice Jewish name.
I was sitting up front of the taxi, these three women were
in back— and I said, "Sister, what in the world are you trying
to tell us? Why is it so important for a Catholic university
to have an independent board of regents with no Catholics on
it?" She said, "How would you like to go to a university run
by Standard Oil?" I thought, "Wow, this lady is really
something else, again." You don't talk like that as head of a
Catholic school.
She was last on the program that day. She made it clear
that she was a woman; the three speakers preceding were all
famous men. She said she was an educator, and that she worked
for God through the Church as an institution, that she believed
in the words of God and the works of God, which had to be
taking place here and now— not in the future. I suspect many
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people in the Peace Corps, particularly, were prepared to hate
a Catholic nun, but not this one; everybody loved her. For
this person to steal the show from Earl Warren, and Humphrey!
She left a message: "You folks went out there and did, here and
now, the Good Lord's work. Now is when it has to be done.
It's not going to be done in the hereafter." She was a
liberation theologist at Webster College.
Crawford: You have to hand it to Shriver or whoever found her.
Blum: Well, yes, I think Len Duhl got her. He was advising Shriver.
I don't know that he thought she would steal the show, but she
surely was the most important person for the returnees. She
was reaffirming what the Peace Corps was all about. Then we
went back to our groups. People spent the next couple of days
trying to figure out how they could use what they had learned
about working with strangers on their terms in their homelands
to improve life. Also, you don't join the Peace Corps because
you think everything's perfect here. It was really one of the
highlights of my life. In fact, I was on a high for several
weeks reliving the wonderful feelings I got from the returnees.
Crawford: And did you work something out that was positive?
Blum: Not specifically, but I don't think too many people left
feeling that their life was wasted or that their Peace Corps
experiences were useless. We see them coming through here all
the time at the School of Public Health, School of Social Work,
ethnic studies, planning, anthropology, sociology, and so on.
Those were experiences that reaffirmed the relevance of
taking care of human beings through more than medical care, and
helping people to help themselves as a community. Medical care
is just a small, little piece of it; this is the big stuff, and
yet it's health. Some of these streams have run all through my
life and reaffirm my beliefs about democracy and social
justice. I've never changed. The same theme is still in my
mind. I suspect that's sort of narrow-minded. Maybe also I'm
not bright enough to think of anything else.
Other Streams; Creating Air Pollution Control Legislation
(1955) and the John F. Kennedy University (1964); the Orinda
Vision Study (1959)
Blum: There was another aspect of the environment that we played a
role in--air pollution control. That was very fascinating; I
219
had an opportunity to work from scratch on that. I was invited
to a Bay Area Council meeting- -it was at the Cow Palace or some
such place—with all the big business people of the Bay Area.
I was sitting at a guest table, and they were speaking against
having any government intervention on air pollution. They
dredged up this big old chestnut: "We will do it voluntarily.
Look around the room—we control the world. We'll do it
voluntarily. We don't need government screwing this up."
I listened to that for a while, and got to the point where
I thought, "Well, I'll just inform them about what they're
talking about." I stood up— and there was no way they were not
going to have me stand up since I was a guest— and I said, "I
want to comment on your posture. You're taking a very peculiar
and, I would say, unfortunate position in favor of voluntary
control.
"In the first place, you are now telling everybody that you
caused the air pollution, right? How can you control it if you
don't cause it? That's an interesting point I'm not sure you
want to make. The next thing is that you don't produce it— you
don't seem to understand that. Sixty-five percent of the air
pollution in this region is caused by automobiles. There isn't
anybody in this room can do a damn thing about it, as they
stand, voluntarily. So— one— you admit to being the guilty
party, and— two— you offer to fix it, and of course it can't be
fixed the way you're going to go about it. So, you're going to
look very interesting to the populace. You're going to look
like criminals for causing all the pollution and like fools
because you can't fix it."
Crawford: This was before the Air Pollution Control Board?
Blum: Before there ever existed any such thing. There was no
applause or response to these comments; I guess they were sort
of insulting. I got back to my office, and there was a phone
call from an engineer named Bill O'Connell whom I had known for
a long time— shrewd, brilliant man— and he said, "The oil
companies in Contra Costa County would like to have me sit down
with you and develop an air pollution control law." The same
outfit that just got through yammering about voluntary control.
It finally dawned on them that they would be blamed for all of
it, and they couldn't do anything about it. So we sat down and
wrote out what became the Bay Area Air Pollution Control
District Law in the next few days.
It was an interesting experience for me to work with a
superb engineer, and a superb lobbyist, and superb politician,
who wasn't about to have the thing fail, even though he was
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Crawford:
Blum:
hired by each of the four major oil companies in the state, and
then by the Contra Costa board of supervisors. In a few hours,
we had written out the basic law, which is the law today.
He was tremendous. He figured out that each of the
counties ought to have one supervisor as a member on the board
--and each set of cities in a county should have one vote on
the board, too. That would keep them all happy, and establish
limits. These elected officials would make up the Bay Area Air
Pollution Control Board. Then he picked out the individuals
from each county who ought to sit on its governing board. He
started out with San Mateo County, and picked the chairman of
their board of supervisors—that was all right, because it
happens that Martin Poss owned a huge nursery—he raised
carnations — and every smoggy day he lost a fortune.
He had very stringent standards?
Bill O'Connell had super standards. And he found an
industrialist— whose name I don't remember— a retired
industrialist from Marin County who had other reasons for
wanting air pollution controlled, who was on a city council
there. He got the chairman of the board of Alameda County. I
knew him from when he used to take tickets on the Key Line
ferryboats. He was a jovial, red-headed Irishman with a great
accent— he was on the board.
Crawford:
Blum:
So we went through each county selecting by name the board
member and the city council member. And he lobbied so cleverly
that each of these persons was selected by their group as Bill
had intended. Masterful, unbelievable.
Then he said, "We need a technical advisory board. They
are going to have to develop the rules and standards." He's
picking out all the people, and he says, "You be the health
person on it, and I'll be the engineer." He picked a wonderful
architect from San Francisco who's still very active in
community affairs. He picked a wonderful planner as well.
Again he lobbied the yet-to-be governing board members and got
us all appointed to the technical advisory group.
Do you have names?
No, I can't think of many, but Livingston was the planner.
These were just fabulous people. You couldn't get better
people.
The thing went right through the state legislature so fast
it makes your head swim. We left out counties that didn't want
221
to play ball by giving them time to join later and when it
became imperative they cooperate — all the ways of getting
around negative votes. With the four major oil companies for
it, let me tell you, it wasn't much of a deal to get it through
the legislature—and there we had it.
In any event, the very first meeting we had, Goyak from
Contra Costa got up and said, "We shouldn't make the garbage
operators stop burning." Contra Costa was full of garbage
dumps which burned the year around. It turned out he was the
garbage interests' point man, so it started out looking bad for
the district.
Then this wonderful Irishman from Alameda County got up,
and he started a long speech about pioneers coming across the
plains, and I thought, "Oh my, oh my. He should have stayed
with ticket taking. This is bad."
Then- -it ' s just really wonderful how some of these
uneducated people think—he said, "What do you suppose the
first thing these folks did when they got to California? They
set up state government so they could control all the messes
that they found." He said, "I'm suggesting that we're in
exactly in the same position. We've got a new mess. This air
pollution is burning everybody's eyes." This man, it seems,
was very pro-real estate, and they didn't like smog.
So the whole thrust of his speech was history and cops and
robbers, and that the first thing we did was to have
government, and this could be no exception. It really got off
to a great go, and the whole board worked from that day on.
I remember when we held our first organizing meeting. I
don't member how we arranged it, but Poss was the chairman of
the board, just like we'd figured. We're sitting at the Top of
the Mark Hopkins— Bill O'Connell and I are sitting right
alongside of a bunch of newspapermen- -and Martin Poss accepts
the chairmanship, and he says, "Well, we do need a technical
advisory committee." He reaches into his coat pocket and pulls
out a three-by-five card and he reads off all the names, and
the newspaper guys are looking at one another and they're
saying, "How can he have that list with all those names on it?
How did he know he was going to be chairman; that just
happened." [laughter]
So there was a technical advisory board. We met over the
years at least once a month or more, and I was always having to
support Bill O'Connell. Everybody on the technical advisory
board knew that he was the ultimate politician, that he was the
222
rascal that put us all together, and although they didn't have
any reason to be against him, they didn't trust him, because he
was such an effective politician.
So if he would come up with a technical recommendation,
they would automatically set it aside. He was usually right,
but it was interesting that despite his role, which had been so
astute about creating what is a remarkably successful
operation, he still was not trusted by the technical people.
Here he is, amongst his peers in the technology advisory board,
and they don't trust Bill O'Connell. It's really kind of
funny. He saw that; he always got a kick out of that; but I
was defending him all the time. I remembered what he went
through, and I thought he'd done a wonderful job; I never could
have done it.
Crawford: And that legislation is still in place?
Blum: It is. Yes, the Bay Area Air Pollution Control District is the
same district, set up by an engineer to do exactly what he
wants it to do for some very special interests, and he does it
right — and beautifully, and inexpensively.
Crawford: That must have been pretty progressive for the times. Did you
get called on that?
Blum: No, I don't think I was even perceived as an actor. I made my
spiel in the right place on the right day; the oil companies
produced Bill O'Connell, and the job was done.
Crawford: It's a real success story.
Blum: It was taken for granted I would be on the technical advisory
committee. I was at least as alert as any other health
officer. In fact, being a chemist originally, I might know
what we were talking about. So that was kind of a fun
diversion. I loved the Contra Costa job that made this and so
many other things possible for me.
Crawford: Your stock must have been very high with the funding
organizations.
Blum: I think it was with various nongovernmental organizations. I
think it was, but all it required was that you were doing
something that was tangible and needed.
Crawford: Were there such programs elsewhere?
223
Blum: There were in some counties and not in others. Alameda County
Health Department had its bright spots. It was a real pusher-
conservative in some ways because they wanted to be big and
they absorbed everything they could, which was kind of tragic
because they couldn't get away with it. We didn't want to be
big, so we weren't, but we got the programs going even if they
weren't in our department. We had a much better school health
program than they had, much better mental health—all kinds of
things --without us owning any of it.
Let me go into one more thing: I was on the original board
that set up the John F. Kennedy University in the early 1960s,
and I've been bumping into them again recently. It's
interesting how these things circle around.
Crawford: Is that what you call another stream?
Blum: Yes. And this was how we could get something indigenous into
the county that would teach mental health, teach this, teach
that — all sorts of health and social justice things. Harry
Morrison, who used to teach administration at St. Mary's, had
become a banker, and all of a sudden, he was well-to-do. His
wife is still alive, I understand, and still on the JFK board.
He got the idea of setting up the university, and decided on
the name J. F. Kennedy because, amongst other things, he
thought we would get big money from big folks, which was wrong
--we never got a single dime from that crowd.
He and I had been opponents forever; he represented the
taxpayers' association, and every time our budget came in, it
was always growing as the county grew. He was the
representative, the spokesperson, for the "poor" taxpayers, and
what is this health department doing? It has gone crazy. So
Harry and I were always tangling in front of the board of
supervisors. He'd give them this big spiel--he was kind of a
bombastic character, but not a fool--then afterwards, he'd put
on a big smile and take me out to lunch or something. Business
is business. He worked for the taxpayers association which, of
course, is paid for by large taxpayers.
Harry got the idea of setting up this university, and he
came over to see me about it. We weren't the best of buddies,
but we weren't enemies. He said, "Why don't you sit on the
board and maybe take a hand at shaping the health part of this
thing? Here's what this university is about: in the first
place, anybody can come in who wants to- -there is no such thing
as prerequisites. Many people who have bad high school
records, bad college records — if they want to try here, they
can. If they can't do it, they will leave." I loved that.
224
Second paragraph was even better—and this from a banker.
"We are living in a new world. This world is one world, and
yet we don't know about other religions, other cultures in this
world and in our country. We don't even care. That's got to
stop. We're just going to be in endless wars and stupidity.
So every student has to take a year's worth of courses on
religion and culture before they graduate, so they feel that
there are other people in this world." So I said, "Harry,
you've got something," and I signed up. It was just before I
came to UC Berkeley.
He got the head of the county library, one of those superb
people who came out of Louisiana, where she hauled her books
around through all the swamps on a boat. She was a real
operator, a tremendous librarian—set up all the good libraries
in Contra Costa. The county wouldn't pay for them, so she got
the neighborhoods to do it.
Crawford: Public libraries?
Blum: Yes. First class. And then Harry got the county assessor to
join. You say, "Why would that be?" Well, to establish a
university in the state of California, at that time, you had to
have at least thirty-two thousand dollars worth of assessed
property—assessed evaluation— that was the criteria for
universities in California. We had gotten as a gift an
abandoned undertaking parlor. We got the assessor to assess it
for thirty-two thousand dollars. [laughter] It was a big
funeral parlor in Martinez which was used by JFK for ten years
as its headquarters.
So here was the assessor; then we had the county
superintendent of schools office— the assistant superintendent,
actually— giving it their blessing, the county superintendent
of schools office can be very powerful, especially in a
negative way.
Harry gathered up some folks from industry like DuPont and
others who would help set up the chemistry department and give
it some status. He got some good lawyers to set up a law
school and some psychologists — and that's a big school there
now, the psychology department. The reason I am thinking about
it is that I was invited to give a lecture there the other day.
They have now moved to Orinda. The man who headed up the San
Francisco Foundation, for which I worked off and on as a
consultant, was the first full-time president out there.
Crawford: Who was that?
225
Blum: Bob Fisher. So, all of a sudden, JFK kind of looms large in my
head again when I was asked to give a class. It was a fun
class. It was psychology—a graduate psychology course—and
the students were older people, not kids. They're using
classrooms in one of the grammar school campuses which they
have as a gift from Orinda. Harry was a devil—Harry Morrison,
the guy that started all this— had to get the accreditation for
the university, so he borrowed it from St. Mary's, where he was
a professor. They agreed to the use of it. They were an
umbrella for JFK.
Crawford: They can do that?
Blum: Oh, they do all sorts of things. He needed a library, so the
librarian Bertha Helium contributed thousands of discards, but
that wasn't enough. If you were accredited, you could get a
free library- -many thousands of volumes. But you couldn't get
the accreditation without the library; on the other hand, you
couldn't get the library without accreditation. So, one day, I
came to a board meeting in the mortuary, and here's Harry and
two other men shaking hands, and one of them is the
accreditation guy, and the other is the library guy— he's got
them to sign on at the same moment.
Crawford: [laughter] This is a real mover.
fi
Crawford: It sounds as if whatever was going on, you were a part of it.
Blum: Sometimes, yes, that was the fun of Contra Costa. I remember
Harry Morrison and I going to the University of the Pacific— in
those days it was the College of the Pacific— and a former
president of the student body at UC Berkeley was the president
there. We went to ask him how to raise money, and had a pretty
long talk about it. We spent a whole day with him in his tank
house— you know, the big, rural tanks, the kind with the long
stilts and the big round ball on top? There was a lot of space
in the structure, and his office was underneath the tank.
We took an elevator up there, and we sat in this wonderful
location at UOP/COP and learned how you raised money, how you
had to put people ' s names on things , and how you had to do
this, and how you had to do that.
Crawford: Were you active in the fund-raising?
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Blum: Not really, because I came to the university at that point. I
resigned there, saying, "I work here; I'd better not play games
out there."
Crawford: You moved here, I'm assuming, as soon as you changed jobs?
Blum: I moved here, yes, within the year. So I left that behind, but
then my wife knew about all these games that were going on at
JFK, like getting the library and accreditation together, and
that we got a big piece of land from a lady in Yolo County who
thought that we were going to move there, and I don't think
that Harry dissuaded her.
We moved here. One day my wife is in Safeway, and she
hears a lady talking to an old friend—they 're meeting at the
counter- -and saying, "Where's your son?" "Oh, he's out at JFK
University." My wife couldn't believe it was real because she
knew all the monkey business side of it. So she turned to the
lady and said, "Going to school out there? Really?" "Oh, yes.
There's six thousand students." She remembered very well the
two Sundays I had to go over there when we first got the
funeral parlor and help clean it up. There were these big
baskets where you kept people, and there were thumbscrews—to
keep people looking relaxed- -well, we got quite an education at
the funeral parlor. We painted, we cleaned, we scrubbed, and
there it was. I can tell you that some of us got a little
queasy. We just weren't used to the undertaking business.
Crawford: What is the reputation of the school?
Blum:
Pretty good, pretty good. The psychology thing is fun. There
are some fun people there, and we had quite a day a couple of
weeks ago when I gave a two-hour class on aging and the utility
of combined human services.
Crawford: You can get your degree?
Blum: Oh, yes, and they contribute people to Over 60 's clinic to work
there. Over 60 has volunteers from both students and faculty.
So it's a real part of the community; it's for real and it's a
big operation. So I always feel good about JFK University.
Well, there's one other stream of concern from Contra Costa
that also influenced much of my life ever since I left there.
I wasn't there too long when I discovered that a couple of
optometrists who belonged to the Lion's Club--the Lion's Club
is always doing things with vision—were going to do an eye
exam of every grade-school student in Contra Costa County to
find the kids who couldn't see well and needed care. That's
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always been a problem. People wonder why their kid drives a
bicycle down the stairs and never seems to learn--well, maybe
they can't see. So the whole business of learning in schools
is partly lost on kids who've never seen the blackboard and
don't see the teacher all that well.
They are going to do a real checkup, but there's great
argument in the field about how best to do it. The
ophthalmologists don't want anything to do with it; they say,
"Let the school nurses use an eye chart," and the optometrists
are saying, "That's pretty sick. It ought to be done
properly. "
So the optometrists got some big machinery and planned to
do the whole county. The only catch is when the optometrists
go into the school district, every kid who's found to have a
problem tends to be sent to the optometrist who came in to do
the exams. It's just the way it would work out. Whose card
are you going to give them if the kid needs eye care?
Well, that's pushing it a little--that ' s unfair trade; and
I hear about it from the school superintendent. "We're getting
ready to have this big thing, is this all right? Does this
make sense?" He's calling the health officer for advice. I
said, "Hold it up just a little bit, and let me think about
it." So I found some articles in the literature, and those two
instruments they were going to use gave terrible results. They
refer about as many people who are normal as they do abnormal,
and they miss about half of the abnormals. Those two machines
are not worth a damn.
So I said, "Well, these folks are serious, and the Lions
are serious, so why don't we really figure out how to do it
properly? Let's set up the Orinda Vision Study." It wasn't
called that then, but we would pick a community where everybody
could afford to go to the doctor, so we wouldn't be examining
kids who could not get needed care afterwards. When we got
through testing with seven methods that we knew about, we could
send a group of these children to UC Berkeley Optometry and to
Stanford Medical School Ophthalmology- -which was in San
Francisco--to be reexamined to see how good these tests were.
We'd have all the reports from all the tests in front of
us , and every kid who was found with something abnormal would
go to these two centers, as well as a sizeable group of
normals. It really was the first good vision study ever put
together.
228
Crawford:
Blum:
I decided that we would do the testing out of our own
budget, but we needed a little extra for records and phone
calls to parents about the results. The county administrator
who had been involved in selecting me for the job said, "All
right. The county will put in five hundred bucks." Well,
that's nothing for a study like that, but really it was good.
The optometrists will do their tests for free; our staff will
do the other tests. Then we have to call the parents.
It was a perfect situation, and the logic was that poor
people don't have much different eye trouble than well-off
people, therefore, we're going to work with the well-off people
who could get the tests at UCB and Stanford, as well as buy
needed care, glasses, whatever.
We got the state health department to do the statistics.
We found an optometrist, who was a neighbor of mine and a
professor at UCB, and who later became the head of health
sciences at an Alabama University, to invent a quick way of
testing in the schools.
What was his name?
His name was Henry Peters. He's the second author on the
study—the Orinda Vision Study. Henry designed a whole new way
of testing kids. It was cheap and brilliant, and it took an
optometrist to do it. Of course, they were willing to work for
nothing to prove the point that they could do a good job.
So we did a thousand kids, roughly, in Orinda for two
years, enough to follow the same kids to see if they changed,
and nobody had ever done that before.
What we discovered was that not only did we find all the
bad eye problems that we needed to find, but we also discovered
that some of the changes at the end of the year were not the
ones that were predicted in all the textbooks, which is that
everybody gets more and more short-sighted: not so. And there
were visual changes in various unexpected directions. There's
a huge Vision Orinda Study now following up on that,
a big-time science study.
Now it's
Henry Peters developed this new method, which was called
the modified clinical technique (MCT) . I phoned all the
families to tell them about the findings. I made all the phone
calls myself. Every time that I got to a father in Orinda, I
also, ultimately, had to talk to the mother. The fathers were
of no use whatsoever, and knew it.
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Crawford: It's not their business.
Blum: It's not their business. So, here's a woman: "You called my
husband, and he really couldn't tell me any thing- -what is it?"
So, I'd say, "Your child was examined and we found nothing,"
or, "Your child was examined and there's a possibility of this,
that, and the other thing; and we'd like the child to go to two
separate universities--UC Berkeley and Stanford—to be re-
examined," if that was the case.
Well, to make a long story short, we got a team to head up
the study. The expert from Stanford agreed--! was on the
faculty at Stanford, at that time, at the medical school. I
went to Ed Maumenee, a famous ophthalmologist. He later left
to head up the Wilmer Eye Institute at Hopkins; and that's the
pinnacle. When he left Stanford, he picked one of his
associates as the participating doctor. Well, that's all
right. That's the man's name that appears as one of the
authors of the study. In any case, we proceeded, we got all
the results together, and on every Thursday night for one year
--I had all the records—we sat in the ophthalmologist's office
in San Francisco, studied the results, and wrote the book. The
University of California Press published it in 1959, and it was
a classic.1 I could go anywhere in the world where there was an
optometrist and say who I was, and they would bring out the red
carpet .
Crawford: That was very exciting.
Blum: Yes, and what it did was mortify the ophthalmologists because
it turned out that the optometrists using the MCT, which cost
fifty cents a head to run, had found everything that was ever
found on the students at Stanford or at UC Berkeley from
traditional extensive testing. It was a brilliant, really
brilliant inexpensive screening. It's of interest that the
Department of Optometry is just now taking the MCT to China,
where they will train people to use it and then do all the
children in China.
Henry Peters was just a genius at this sort of thing. It
brought me the Apollo Award in years to come, an annual award
from the American Optometric Association for a non-optometrist.
The book was published and the ophthalmologists started
screaming bloody murder. It was in the code of ethics of the
AMA that no M.D. shall communicate with optometrists. That was
'Vision Screening for Elementary Schools: The Orinda Study. Blum,
Peters, Bettman. UC Press, 1959.
230
inserted in the code by request of the ophthalmologists in
1955, a turf matter, of course.
Crawford: Is this still going on?
Blum: Well, no. They got rid of that law a decade later. As soon as
we were published, we had a second printing. We didn't get a
dime for it because this was a public service thing. You saw
it; it was in soft cover. I got a notice from the AMA that I'm
about to be tried for unethical behavior, consorting with
optometrists, but they are sending this to the California
Medical Association because I'm a member here.
Then I get a letter from the CMA that they're sending it to
the ACCMA because I'm a member of the Alameda/Contra Costa
Medical Association, and I will have a trial for being
unethical, working with optometrists, for figuring out a method
of testing school kids' eyes — the first time it's ever been
done properly, and a beautiful test, besides.
So my wife says, "We don't have to put up with this. You
get on your best suit and go down there and sit through this
hearing. I'll drive you down, so you're relaxed. If there's
any crap, you just tell them that we're going to hire a lawyer
and go the whole way."
I had a committee of about twenty doctors, headed by a
urologist, whose son is now a very prominent urologist down the
Peninsula. They sat me down and they read the charges:
cooperating with optometrists. The first thing they wanted to
know was, "How much did they pay you?" Which I don't think was
a good reflection on physicians — to bring that up as the first
question. I said, "They didn't pay me anything--! 'm a health
officer." "Well, why did you knuckle under to these rascals?"
I said, "I'm concerned with the health of the kids." "Why
didn't you use ophthalmologists?" I said, "Well, the truth of
the matter is that I asked, and none of them in the East Bay
wanted to play; but I did get the world's most famous
ophthalmologist to play--Maumenee, who is now at Hopkins."
That kind of cooled them off. Then, "How much did you make
from the book on the royalties?" I said, "Well, it just so
happens that this is known as a service kind of book. UC Press
does not pay its authors anything for this kind of book." I
said, "Look, we ended up figuring out how to do it right, and
we checked it out all the way around, and all the other tests
were terrible; we tested them all. They said, "Well, would you
write all this up? We'll send it on to the AMA." And I
submitted it shortly after that time, and the case was removed.
231
And as I said, this portion of the code of ethics was deleted
by the AMA a decade later.
The reason I wanted to get into this study for a moment is
that this all started as a health officer getting five hundred
dollars from the county administrator, who is putting his
blessing on it. It made me very visible to the optometrists
because I took the heat for it—tried for being unethical. Of
course, I was exonerated, but the optometrists were well aware
that I had been willing to put my name up front when it was
known to be a risky thing.
Crawford: Had you jeopardized your position at Stanford?
Blum: Not at all, not Stanford, and with their celebrity Dr. Maumenee
on it. But it is of interest that in the sixties, the UCB
School of Public Health wouldn't take optometrists. But the
same university has a school of optometry--the best in the
world.
The head of the Health and Welfare Committee of the
California State Assembly was an optometrist—Gordon Duffy--and
he was not unaware of what was going on. I worked with him on
committees, and then one day I was sitting at my desk at UCB,
and he called, "I'd like to do something for you- -what can I
do?" I said, "Well, we're working on trying to set up a
medical school at Berkeley." He said, "Good. I'll have some
policy analysts work that in to some other piece of
legislation," and we wrote up the medical school at UC Berkeley
that's here today — and it became law.
Blum: I'll continue with this stream of events which eventuates in
the medical school at UCB, known as the Joint Medical Program.
When I got to UCB the campus under Chancellor Roger Heyns
was looking at the advisability of creating a medical school in
the East Bay, which was the largest population aggregate in the
U.S. without a medical school.
Bill Reeves and Ned Rogers were on a campus committee
studying the pros and cons and Ned became the chair. When
Roger Heyns left, he was replaced by Albert Bowker, who was
specially interested in a medical school, having just launched
an unorthodox one at City College of New York.
The committee met almost weekly for lunch in Bowker 's
office and chewed over every aspect of the matter. I was
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appointed to it shortly after my arrival and enjoyed every
minute of the planning for a medical school without walls,
using primarily local practitioners as faculty and the
available campus courses for the basic sciences. There was
such a school at Michigan State just being set up by a former
dean of the medical school at Stanford. He became one of our
outside advisors, bringing with him a faculty person in charge
of their pediatrics and genetics who spent a year here.
As we got closer to a conclusion, we worked with our two-
county medical society, ACCMA, won its hearty approval as its
members would be playing such a key role in teaching.
However, the president's office at UC was getting a
powerful barrage against the unorthodox proposal from the other
medical schools in the system. They didn't want to share any
funding with another medical school and they hated the proposed
unorthodox approaches to teaching as well as the offensive
notion of training primary care or people-oriented physicians.
A canvass of UC medical school deans showed only one in
favor. The very antiquated dean at UCLA was away and a friend
of mine from Hopkins days was acting dean. He called me and I
helped him compose a very positive letter.
At that point the president of the university, a well known
planner by the name of Charles Hitch, sent Bowker a letter
advising him to forget the medical school. Bowker was a soft-
spoken man of action, and used few words. At our weekly
meetings, he rarely spoke, but when he did it was decisive and
to the point. Bowker raised his hand and asked our committee's
permission to read a letter from President Hitch which went to
the effect that it was time to bury the Berkeley Medical
School. It opened, "Dear Al."
Bowker then said he would like to read us his reply, which
was, "Dear Charlie, thought you'd be interested in the
enclosed." The enclosed was the new state law I had handed him
a day before which had just been enacted saying that "there
shall be a medical school at UCB."
I won't go through the school's ups and down, except to say
that Robert Biller, now provost at USC and then associate
professor in public policy, provided the intellectual and
philosophical framework for the effort. He became the first
director of Health and Medical Sciences which had five arms — an
undergraduate effort for the pre-health career students, an
unorthodox breed of intermediate level mental health
professionals, the unorthodox medical school, a genetics
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counseling program, and a dual degree effort under Dr. Leonard
Duhl.
Although I had opted for the undergrad program where some
four or five thousand pre-med, pre-dental, pre-nurse students
throve on Shakespeare and chemistry and needed some sense of
what they were getting into, I was soon detoured into the
medical school and put in charge of the clinical aspects
because I was the only M.D. on the committee that knew great
numbers of local physicians, hospitals, health departments, and
had also taught in medical schools.
I became half-time with the medical school and organized
the medical exposures of the twelve students in the entering
class, found them practitioner preceptors, organized physical
diagnosis, hired the clinical professors who opened up the
program. I found these people with the help of Dr. Norman
Sweet of UCSF, a student's hero, and Dr. Sheldon Margen of the
School of Public Health, who had just left private practice in
Berkeley for a professorship at UCB and had been our family
doctor (he's the father of the Berkeley Wellness Newsletter).
Another new president of the UC system forced us into a
joint venture with UCSF so as to avoid creating a full-fledged,
four-year medical school in the East Bay. I had my last tangle
with UCSF over the transfer of our students to UCSF for their
third and fourth years and thus their M.D. degree. They
decided that they would not accept our students after all.
That was a potentially lethal blow. So I went to work and
called in all my chits. Stanford agreed to take six of the
twelve, USC one, Harvard one, Rochester one, Hopkins one, and
at that point UCSF said they were just kidding, they would take
the whole class, provided they got half the faculty funding,
which they did. About half of our first class did go to UCSF
and all of them have from then on.
Since a partnership with my beloved alma mater, UCSF, was
not what I had been working for, I left the program in about
1974 and never touched it again until 1991.
Business Activities in Contra Costa County if
Blum: By 1960 I had done quite a few things. I had finished my
vision study and was writing my book on administration and was
probably a little tired of Contra Costa at that point, I'm not
sure. So I started looking around, and I thought other people
234
in the health department might be interested in opening a
really good medical practice. We looked at a walnut orchard in
Concord and thought that might be a good place for a health
center. We bought the land inexpensively and then got cold
feet about going into practice. Subsequently we thought we
might want to make a shopping center. We couldn't get zoning
for that, and then we sat there on this sizable investment--! 'd
involved all my friends and all the doctors in the department,
and even my secretary. So we created a corporation and we'd
had a dream of building low-cost housing there and couldn't do
that for other reasons, primarily financing. We created three
corporations: a real estate managing group, a real estate
development group, and a construction company.
We finally built a mobile home complex. Our one
businessman partner had an unerring eye for what should be
bought and what sold. He received 10 percent off the top for
each purchase and likewise for each sale, a potential gold mine
for him, but he just couldn't resist helping himself to our
assets, since he was also our manager for the mobile home park
and for our construction company.
Fortunately, he had to go away for a national convention of
his service club, and I automatically took over the paperwork.
It was pretty shocking to discover that we hadn't been paying
our bills and that we owed some $80,000 just to our lumber
company. I removed all the files from his office, went through
our finances, and discovered that the missing funds had gone to
building him a magnificent home.
Just prior to this rude awakening, our last quarterly board
meeting had taken on a bizarre set of new rituals. First a
minister came and gave us a blessing, and then we had a flag to
salute. The reasons for the appearance of these morally
edifying rituals was soon evident. Fortunately, I had all this
partner's shares in these three corporations in my safe deposit
box and it wasn't too hard to set the accounts straight, and
divorce our errant partner.
In addition to learning about partners, we learned a lot
about real estate zoning, borrowing, naming business
corporations, and some basic rules of survival.
One of the socially useful things we tried to do was create
elderly- friendly low-cost housing. We found an Oakland
architect who specialized in such work and created a plan for
three low-cost acres in Concord, which were really a marsh
between two creeks that were being rerouted. The marsh
disappeared and became a lovely gentle hill when all the local
235
contractors used it as a dump for their unwanted fill. I was
in Washington frequently and went to see the FHA office that
also guaranteed loans for elderly housing. All that they
required was a location three blocks from a shopping center,
which we were, less than 35 percent coverage of the lot, which
no developer could afford, and concrete and steel construction
with elevators for a two-story building for people who were
currently living in multistory fire traps paying several times
what we would be charging.
When I asked the federal loan officer if he was ever
concerned with creating low-cost safe housing for the elderly,
he allowed that that was never a consideration in their
offices. They were concerned with keeping real estate
interests and contractors happy. We sold the land to a real
estate developer who had ample funds and built lovely
apartments with tree-shaded walks, but for better-off people,
aged or otherwise.
Another lesser disappointment was my design effort for the
mobile home park which we called The Trees because it was going
into an older walnut orchard. We surveyed it and I designed
the park so that we would spare almost all the trees. In
Concord's warm climate, that would be quite an asset. What 1
forgot was that all the utilities which were going underground
had to get to the unit pads, and inadvertently, we lost about
half of the remaining trees as a result of placing the
utilities to the pads.
I did all this in early mornings before arriving at work in
the health department, in the evenings, and on weekends. Once
the new ideas were in place, the only interesting aspects were
new acquisitions and design of new structures. But the
nuisance of day-to-day transactions, after they fell on me,
weren't worth the efforts, and since no one else wanted to take
over, we began closing out. It took about ten years to get rid
of the last bits and pieces, but it was all very profitable for
all the partners and everyone left with a good feeling,
although it was apparent that we could all have become
millionaires in that real estate boom if we had stuck it out,
and if I had continued the managing and entrepreneuring, which
none of us looked forward to.
One of the side effects of my business matters was the
status it earned me among some physicians. Physicians in fee-
for-service practice (the main form of practice then) were not
overwhelmed with respect for public health M.D.s whom they
regard as salaried renegades and traitors, or as physicians
incapable of making a living in practice. In fact, in the
236
western end of the county, I was cordially hated in some
quarters because we held free well-baby clinics, prenatal
immunization, birth control, and children's cardiac clinics,
among others. Scathing letters would go to the medical society
about my socialistic tendencies, i.e., stealing private
practice patients. Then I would go to a medical society
council meeting and explain our work, our duties, the laws we
were under, and get a grumbling acquiescence. As a result of
the success of the mobile home park, I was invited to address a
hospital staff meeting on investing in real estate, although
the meeting was billed as something about health.
A House in Berkeley
[Interview 5: March 29, 1997] ##
Blum: In the final chapter of this relatively important break in our
history, we moved to Berkeley. We came here in 1966, and
somewhere around that time I got a Margaret Sanger Award from
Planned Parenthood. When we got to Berkeley, we decided to
build a house and bought a lot. But I couldn't get a building
permit. We'd bought the land, had a surveyor, architects,
contracts, everything ready to go; and the city wouldn't sign
the building permit.
We fooled around for a while, and finally I thought, "I
wonder if there's something political about all this." I went
down to the building department and the building inspector
wasn't in, although I had made an appointment.
Blum: I remembered my days in San Diego, Contra Costa, and elsewhere
--you deal with people who seem to have authority, and maybe
you just have to play the game better than they do. I said to
his assistant, "Well, I'll just sit here. I'll clear my
schedule and I'll be here tomorrow. I know the chief is bound
to come to his office, and I'll be here." That's the sort of
treatment that they don't know how to deal with.
In any case, the assistant inspector who had spoken to me
was very embarrassed about all of this. He was, clearly, very
uncomfortable when I couldn't get a permit signed. So, when I
came the next day, he said, "Come in the office and sit here."
We sat down and chatted a little bit about things, and he said,
"You're a famous person, aren't you?" I said, "Me?" He said,
237
Crawford:
Blum:
Crawford:
Blum:
Crawford;
Blum:
Crawford:
Blum:
"Oh, yes, you." I said, "How would you figure that out?
Nobody ever told me that before." Well, he said, "Didn't you
get a Margaret Sanger Award?" I said, "Well, that's true, but
I wouldn't say that I'm really famous." He said, "Oh, yes.
That's a very important thing. You know, I wish we had known
about those things when we got married. We have an awful lot
of kids." [laughs] He's sitting there, admiring me, and he
said, "Give me that goddamned permit," and he signs it and
says, "Go ahead—build your house." [laughs]
This is very puzzling, though. What was the basis of their--?
Of their holding it up? Well, I learned, ultimately, after the
house was built. It turned out that nobody in the neighborhood
was in agreement. They just didn't like the house.
Really? The plan?
Yes. It was something I did myself, and really very
conservative, with shingles and two almost flat roofs--you
could say two matchboxes lying one next to the other, with one
roof overshooting the other and facing north—really, a very
attractive house, everybody said. It turns out that a fair
number of neighbors had Cape Cod houses, and a fair number had
Spanish houses, and they were seeking a compromise on a Spanish
Cape Cod. [laughter]
They didn't come forward and say, "This is what we think"?
Oh, no. We had a hearing because, I think, we came closer to
the street by a couple of feet than was allowed, and the issue
of style never came up. A neighbor told me about the
reservations years later—one of the neighbors who had lived
there all of his life in a Cape Cod house.
That brings you to Berkeley and your house,
your house?
Do you still like
Oh, we love it, yes. I somehow knew Roslyn Lindheim— does that
name mean anything to you? Well, she was a professor of
architecture, here, and a very unusual person.
My appointment here for a few years was half-time to the
Department of City and Regional Planning, half-time to the
Department of Public Health, so I had a foot in each of those
places. City and Regional Planning is the sibling of
Architecture and Landscape Architecture in the Department of
Environmental Design, so I was on the faculty at the Department
of Environmental Design here, and I guess I met Roz that way.
238
Since we were contemplating building and had bought the
lot, I asked Roz to come and look at it, and look at my design.
Then I said, "Roz, would you care to be a consultant on the
project?" She said, "Well, would you listen to a consultant?"
I said, "Well, no, probably not." She said, "Well, then what
do you want to pay one for?" [laughs]
We became good friends over the years — a very interesting
person—passed away now— but she's the one who thought up the
concept of On Lok. That didn't start from anywhere else. This
was Roslyn Lindheim. Do you remember the Plane Tree in San
Francisco—the place where folks could get information about
health and sickness? It was right near Stanford Medical
School— it was the old medical school library— and when
Stanford became California Pacific Medical Center, Plane Tree
ended up having a ward in the hospital called the Plane Tree.
It was a different kind of service where people were treated in
a very different way. All of this was Roz Lindheim also.
Crawford: Where was it, exactly?
Blum: It was a ward in CPMC, but the original little library that the
public could use— which had the technical articles and the not-
so technical articles— was right next door to the old Stanford
Medical School, which is where CPMC is now located.
Roz worked for Stone, Maracini and Patterson, the big
hospital architects. She was one of their head architects, and
she got to hate hospitals, or to be exact, the process of
hospitalization. She thought of all the ways of avoiding
hospitalization, or at least of making it bearable, that was
the Plane Tree unit, and that's what On Lok was all about—
avoiding hospitalization altogether.
In any event, Roz was the consultant for our house, and she
made two suggestions, shorten an overhang and take out a corner
where the hall entered the living room.
Then I took my plans to an architect in Walnut Creek; I
didn't know the engineering; I didn't know the right size of
windows— all the things that make a difference, that make it
simple to build or complicated. He took my floor plan and the
side, front, back, views, and he put the plan together. Well,
it wasn't Spanish and it wasn't Cape Cod.
Crawford: And it was accepted?
239
Blum: Yes. Nobody seemed to want to fight very hard, and it's still
there.
Crawford: And you're still in it?
Blum: Oh, yes.
Health Officer, Contra Costa County, 1950.
President, Health and Welfare Council
of Contra Costa County, 196A-65.
Teaching at the University of California,
San Francisco, 1969.
Opening of the Joint Medical Program at the University of
California, Berkeley, 1972.
240
VII MOVING TO BERKELEY: THE UNIVERSITY AND OTHER INVOLVEMENTS:
1966-1984
Joining the University of California Faculty and a Campus
Revolt
Crawford: That's grand. And that brings us to Berkeley.
Blum: I started full-time in Berkeley in '66, and that was an
auspicious, grim year. And a few years thereafter Mr. Nixon
had us invade Cambodia. This place really blew up again.
Students and even faculty. I mean, what's the use of teaching,
what's the use of learning if we're just going to invade
countries — take out a whole country because we didn't like the
Vietnamese. We're going to clean out Laos and Cambodia because
our enemies were using routes through those countries to move
equipment and supplies and troops; we just extend the war at
will. This place blew up. We had an official holiday here.
There were very few classes.
Crawford: You were familiar with UC as a lecturer.
Blum: Well, to backtrack, I had come in for one course a semester, or
sometimes for two semesters a year since 1951, to give some of
the regular courses in the School of Public Health.
Crawford: So that you knew the dean and you knew the faculty?
Blum: Sort of. The dean had a long history of relationships with me,
as you know. It was Chuck Smith, who was world-famous. He
discovered and clarified a horrible disease, valley fever or
coccidioidomycosis. Chuck's name became synonymous with that,
but he was also the dean at the School of Public Health when I
first came back to this area after Harvard and from San Diego.
I came to Contra Costa in 1950, and I thought it would be nice
to teach somewhere, so I came over to the university, here.
The School of Public Health at one time was housed in one of
241
Crawford:
Blum:
the crummy little World War II relics in the glade there near
the library known as the "Temporaries."
Ned Rogers, who was the head of administration and a very
nice person, said they didn't need anybody, but Bill Reeves,
who now has the office next to me and who soon became the dean
after Chuck Smith died, thought they could use me, and they had
a very special use for me — teaching epidemiology to students
who didn't speak much English, or to students who had no
science background, so that they were presumably incapable of
handling the material. [laughs]
They got rid of those students out of the epidemiology
classes, and gave them to me. I had a great time, because it
just suited my needs. I knew epidemiology pretty well,
although I'd never had a course in it. It was a natural kind
of teaching--it was cause and effect, relationships,
correlations—all the stuff that came naturally to me.
You said, when I first talked to you, "I thought this way."
Yes, so I had a great time with these students, and some of
them really learned more than they ultimately would have in the
regular courses.
This was my relationship with the school, on and off.
Chuck Smith was called the first dean here; he was really the
second, it's a long history—it' s in Bill Reeves' oral history.
But Chuck Smith had sat on the examining boards for me in two
places, when I applied to Contra Costa for the health
officership and when I applied to San Mateo. In both cases, he
saw to it that I was number one on the list. There wasn't any
question that he knew who I was, so when I showed up around the
school, he seemed interested in putting me on. He was closer
to epidemiology than he was to administration. In any event, I
later moved from that to teaching administration when they had
some holes in the administration faculty.
Blum: One of my early teaching successes was with a group of master's
students learning more about administration. A good many had
experience and all in all we had a lively two-hour seminar each
week. It was often a shared session with Al Leonard with whom
I later wrote a text on administration. The class began at ten
a.m. and nobody seemed to want to quit at noon.
In the next year using our same open-ended approach with a
very comparable group of students, the class was okay, but
242
Crawford:
Blum:
never was scintillating as in the year before. The third year
was about like the second one. At one bull session about how
courses worked and didn't work, I learned that in the first
year in the eight- to ten-a.m. time slot preceding our ten- to
twelve-session, Helen Ross, more recently the head of health
education at San Jose State University, had been doing her
thing for the same group of students who stayed on in the same
room for our class. Her thing--how to turn students on and get
them enthused. But she was no longer there in our second and
third year repeat. I have always been suspicious that Helen
Ross was the cause of our first-year success. Perhaps a
successful class depends heavily on what has happened to the
students in the hours just prior to getting to one's class, not
on the giftedness of the instructor in the class.
f*
You told me there was nothing for you to do because there
wasn't much going on in the area of administration.
Yes, but I'd written that book on administration [Public
Administration: A Public Health Viewpoint] . I was fairly well
known to a lot of people.
Crawford: And there was a Stanford connection, as well?
Blum: Well, that was another story. That was every Friday afternoon,
beginning in 1950, when I came back to the Bay Area, right up
to 1960, when Stanford Medical School left San Francisco and
went down to the Farm. I kept on for three more years, but
that was a big commute to Palo Alto and I couldn't keep it up.
That was teaching straight internal medicine.
The first week that I came to work at UCB as a professor, I
got a call from Stanford from then-dean Glaser saying, "Come on
down and talk about teaching preventive medicine at Stanford."
I would have loved to do that, because the place where
preventive medicine is needed is in medical school. Everybody
who comes to a school of public health has already figured out
that that's their baby. In medical school, that's not friendly
territory, but has to be made so.
I'd had a talk with Glaser about that a few years before.
He said, "We don't have a professor in that, so we can't do
preventive medicine now, but I'll call you as soon as it looks
like we can." So he called me, and I turned him down. I said,
"I can't leave Berkeley; I just got here."
Crawford: Would that have been a full-time association?
243
Job Offers from Stanford. New York City, and Los Angeles Health
Blum: Oh, yes. It would be part of the faculty. It's really where I
wanted to be. Well, that was a wild first week here. I got a
call from a man who once worked for me and then ran a voluntary
health agency that had been the backbone- -they and the PTA--of
our doings in Contra Costa County. He said, "I'm bringing up
three members of the board of health of Los Angeles County. We
have the blessing of three supervisors of the five, and we want
to talk to you about coming to L.A. to head up the health
department (which had recently combined the city and county
health departments). I'm representing the voluntary health
agencies, and we promise you every conceivable support. We
just want to clean this mess up." It was really a bad scene.
At the same time, practically at the same moment, I got a call
from Bob Connery, who was the chief of administration for the
City of New York, for Mayor Lindsay. Do you remember that
bright, shining light?
Crawford: Yes.
Blum: He was a Space Cadet--this Connery--a professor of political
science at Duke. That was the kind of people Lindsay brought
in. He said, "I'd like to make you city health officer of New
York." He said, "Let's talk about this for a few minutes, and
I'd like an answer by tomorrow, because it's yours, if you want
it."
Crawford: You've already started here?
Blum: I've started here, and here's Stanford, here's Los Angeles City
and County and now New York City.
Crawford: All these things coming through!
Blum: Yes, and all at the wrong time.
Crawford: What would you have done if you had still been in Contra Costa
and all these offers came in?
Blum: I couldn't go to L.A., because when I talked it over with my
wife, she said, "Look, you go to L.A. I'll stay here."
[laughter] The reason I said I would be willing to go to L.A.
is because it was the last place where you could do something.
It was the last big city where you could put the pieces
together.
244
Crawford: New York would have just been impossible?
Blum: Impossible. It went downhill for the four preceding and all
the following health officers. In everything, the cards were
stacked. The unions were going this way, business was going
that way. L.A. was all free-wheeling. It still is. Real
estate is not in bed with the church, and there isn't any
church to be in bed with. San Francisco is a different story.
But in L.A. the movie industry doesn't care much about the
airplane and manufacturing business or the real estate business
or agriculture; all of these are free-floating power bases and
you could work out things with people.
Crawford: You say the church is in bed with real estate here?
Blum: That's typical San Francisco.
Crawford: What are the practical ramifications?
Blum: Tremendous. I mean, you listen to what the unions and
Archdiocese has to say because between them, they have all the
votes. Down in L.A., it's all wide open. When unions or real
estate or electronics promise to support you, you've got a
vast, free-floating group that crosses all lines. Ditto for
the other major interest groups. It really would have been
fun: the last big chance in the U.S. for running a good major
city-county health department.
Crawford: Did it work out?
Blum: Not very well. They got very, very inadequate people—just
terrible. The new big boss in L.A. is the last health officer
from Contra Costa, and he might make it. He's a clever guy, a
young man.
But that isn't all. This is in the course of maybe two
weeks time. Then I get a call from the University of Hawaii,
saying that they need a dean of the School of Public Health and
the state also needs a state health officer, was I interested?
So I come trudging home each night with all this wild
stuff, and I said, "Well, honey, what do you think about going
to Hawaii?" "Live on an island?" was the response. And you
could just see in her mind a palm tree and a little beach and
some sand. She loves it for a vacation, but not to work there.
New York City—that was the tough one, because that was big
bucks and great visibility. She said, "All right, now, what is
it about New York that would really be so wonderful?" I said,
245
"When you get through with that, you are well known and nobody
can tell fame from infamy there. So however well you do, it
doesn't make any difference." "And so?" Then I said, "Well,
then I can get any job I want, anywhere." She said, "Such as?"
I said, "Well, I can be a prof at UC Berkeley." She said,
"You've got to be crazy. You are a prof at UC Berkeley."
[laughter] That was a kind of irrefutable position or
argument .
So when it all wound down, the only thing she would have
put up with would be to go to Stanford, if that really worked
out. But I'd already committed- -you can't leave Berkeley to go
to Stanford overnight.
Chuck Smith obviously wasn't adverse to having me here,
although I heard from various sources that he was anti-Semitic.
The truth of the matter is he knew very well that I was Jewish,
and he got me first place in Contra Costa, where there were
eighteen or twenty candidates and some very good people with a
lot more experience than I had; and he got me first place in
San Mateo.
He was just a nice guy, a good human being. I have trouble
believing that he was anti-Semitic, he really went out of his
way to get me started careerwise. He was still here when I was
first brought on—that was not as a tenured professor. In any
event, Bill Reeves got me the tenure position a year or so
later. In 1967-68 I was half-time full professor at City and
Regional Planning and half-time here.
That was a start, but really the start was sidetracked by
the campus revolt at UC Berkeley. The terrible thing was that
the School of Public Health students in those days were not
very socially conscious, and they said, "Oh, well, let's go
home." So they left, the bulk of them. This was a big issue
for the country, but not for them.
Crawford: It's surprising to find indifference here.
A Joint Masters Program; Department of City and Regional
Planning and Health Planning: Collaboration with Nathan Glaser
Blum: Yes, it is, but City and Regional Planning was another story.
They were wide-eyed and ran nearly all the campus protest
activities out of Wurster. Practically all the posters were
made, and all the key student meetings were held there. I sat
246
Crawford:
Blum:
Crawford:
Blum:
Crawford:
Blum:
in on hundreds of student and faculty meetings. I tell you,
that was big business, but I didn't have to make a decision
about not holding class — there was nobody left to hold it for
in public health.
And how long was that?
Oh, it was months — several months. The whole semester was
lost.
What was the job in environmental design?
That came about because I was teaching health planning and they
wanted to keep a relationship between the two departments. In
fact, I later engineered a joint masters degree with City and
Regional Planning and Public Health. In three years, a student
gets two masters degrees — one in city and regional planning,
and one in health planning. It's an ongoing program. It made
good sense— there were a lot of brilliant people in city and
regional planning, both on the faculty and among the students.
Environmental design was the school, and this was the
subset. I guess I taught one class up there in the 1970s, and
Bill Wheaton, who was head of the department, introduced me to
the class: "This is Dr. Blum. He's really a public health
person, a physician." He said, "Now, if you're going to be
using his book on health planning, that's the best book. Well,
it's the only book." [laughter] He wasn't kidding anybody. I
don't think he was overwhelmed with the book, although I was
quite pleased with it.
This was Planning for Health [Planning for Health.
Publications, New York, 1974.)
Behavioral
Planning for Health. So, that was kind of fun. At that point,
Nathan Glazer, the famous sociologist from Harvard of Riesman
collaboration fame, was here as a professor in city and
regional planning. It was that kind of a school. They had
superb people.
William Wurster was another one—the building's named after
him- -he was both the dean of architecture here and the dean at
MIT at the same time for several years. It was a nice show.
I've mentioned Mrs. Wurster— her name was Catherine Bauer— was
on Len Duhl's Space Cadets. She was a wonderful person; a
sociologist and a housing expert.
Nathan Glazer and I ended up in the same enclave. City and
regional planning decided to put together a program called
247
"social planning." There wasn't any such curriculum then. So
Glazer and I teamed up on that, and we actually admitted a
group of doctoral students to that program. It was really
meant to be Mel Weber's assignment, but he was on a sabbatical
in England. He was teaching over there.
So Glazer and I held the show together, admitted a dozen
doctoral students—some became quite famous — and I learned that
part of Glazer 's charm was to let the other guy do the work,
somehow or other. He was a brilliant man, and as soon as he
saw an idea, there would be an article springing out, and then
it was published because he was Nathan Glazer. But it was
quite a chore for me, especially as he got really fed up here,
because the university promised him this, and they promised him
that, and produced nothing. He was supposed to have a decent
office and a secretary—he' s kind of a luminary, you know.
Nothing. So he went back to Harvard. I gave up my part-time
work at city and regional planning since I had to do a full
share of committee work for each of the two departments and had
no time left to do anything useful in either.
Crawford: What about the rest of the faculty in the School of Public
Health? I think some other public health officers were brought
on about the same time.
Blum: There was Dwight Bissel, but he was never full-time faculty
here. He was one of the people who competed for my job in
Contra Costa. He used to teach here, off and on. He was a
good man--a very good man—and he was the City of San Jose
health officer. But he was filling in for permanent faculty
that the school didn't have, as I had done earlier.
Then Al Leonard, who also had taken the exam for Contra
Costa, took the job that I left in San Diego and then he came
to be the City of Berkeley health officer. At that time the
university had a deal with the City of Berkeley that three
professors in the School of Public Health would also be the
officials of the health department of the City of Berkeley, so
that we would have a real, honest- to-God training ground for
public health students.
In any case, these people were meant to be both in teaching
and active in public health duties, but it didn't hold. People
like myself came in over the top of them as full-time faculty,
and these people slowly disappeared from the faculty.
One of the catches to it was that the university doesn't
honor people who are doing teaching and paid work for cities
and not devoting themselves to research. It just wasn't in the
248
cards that they would get permanent appointments here, even
though there was an agreement to that effect. It lasted for
half a dozen years, more or less.
A First Course in Health Planning. 1967. and New Legislation;
The 89th Congress, 1966
Blum: I came here in July, 1966, and the new federal planning law was
passed in December, 1966, and I decided to offer courses in
planning in '67. The head in administration was Ned Rogers — a
very lovely Bostonian and just a terrific guy--what you call
an honest, bright conservative who still thought the Republican
presidents were tremendous. We could never discuss things like
presidents, but we could discuss public health, and he wrote
the first book on human ecology.
Crawford: And he'd been dean.
Blum: He had momentarily been dean. He brought in Smith to replace
himself when he was about to become UC's vice president for
health. Because he had the temerity to say publicly that
government should really take over health care, the medical
people in this world wiped him out, and he couldn't be a
university vice president. He was a straightforward, proper
Bostonian, a Beacon Hill-type who believed, and inadvertently
said, that the only way we're ever going to have a good health
care system is by the single-payer system—to provide universal
coverage. Well, that was anathema to organized medicine.
Crawford: How did they move against him?
Blum: Politically, they just saw to it that he couldn't be vice
president for health at UC.
Blum: So Ned Rogers backed away and said, "Well, Chuck, 1 brought you
in to be dean, you're dean, and I'll go back to being head of
administration, a professor of administration." Not too long
after that I came here, and when Chuck passed away, Bill Reeves
became the dean.
Crawford: Talk about the difference in styles.
Blum: I didn't have that much to do with either of them prior to
coming on full-time, you see. As I said, Chuck Smith was very,
249
very friendly, and he was good about human beings. One of his
pet students became the health officer of San Mateo County- -Hal
Chope, after whom they named their county hospital. Chope
caught coccidioidomycosis as a medical student in Chuck Smith's
lab at Stanford. It's a horrible disease; there was no
treatment, and he started going downhill. So Chuck said,
"Let's just never mind you going through medical school. Let's
have you take it easy." They sent him on a trip around the
world. Chuck paid for all of this, as far as I know.
Crawford: Just felt badly about it?
Blum: Yes, and I think Chope wound up in South America, where he
started feeling better. He came back and he was all right, and
he finished medical school and went into public health. It
takes a pretty good guy to accept responsibility for such a
lab-acquired illness. Anybody else would have blamed the
student for breathing too hard, or something, just wouldn't
take it upon themselves—Chuck did.
Chope and I were co-partners in crime for many years- -he
was health officer in San Mateo County and I was in Contra
Costa. He was a good bit older than I and a lot more
prominent. In any event, Chuck took a hand in all of these
things. I'm sure he took a hand in getting him that job in San
Mateo--which was the best public health job in the States.
Crawford: I talked to a student of yours from those early years named
Lucy Johns .
Blum: Oh, wow. Okay. I was going to tell you about Lucy.
Crawford: She told me that you loved the climate on campus; that you took
courses and you were very much a part of the antiwar activism.
Blum: Lucy Johns was in my first class, and, in fact, one of her
ideas was in my first book on planning. Unfortunately, I
didn't notice that when it was published, it said, "Lucy
Jones, " not Johns. It was one of those nice printer errors.
Lucy upbraided me once, in recent years for that. She said,
"You know, I've always held it against you that you didn't give
me credit for that power configuration."
Crawford: What was it, specifically?
Blum: It's a chart describing sources of power in the textbook on
health planning that was her idea. I said, "What are you
talking about?" She said, "Well, you didn't really give me
credit." I said, "Goddammit, let's get a copy of the book."
250
So we opened up the book, and I said, "Isn't that your chart."
"Well, yes." I said, "Well, what does it say?" Then we both
looked, and it said Lucy Jones. [laughter]
She had never bothered to really look at that chart. I
don't know what she thought but, any event, we were always good
friends. She was in my first class of graduate students, and
she was a character. Sometimes she would perch up on my desk
in my office and start giving me a lecture.
II
Crawford: You must have had wonderful students.
Blum: Unbelievable. They were very, very bright; they were young;
they were not coming here for refurbishing; they were not ex-
health officers and ex-this and ex-that, coming in for a year
so they could get a raise or a promotion. These were people
who thought something could be done and should be done by use
of planning. The war had pretty well shaken them up. We were
destroying Johnson's good programs to create an army to kill
all the Vietnamese — a big deal. 1 said, "I've never taught a
planning course." "Well, start . Let's start."
Crawford: It sounds as if the students contributed substantially. Lucy
Johns called your classes a free-for-all. She said you never
stood up at the top of the class and lectured formally.
Blum: I might have gotten more respect if I'd have done that, but
then I probably would have killed the discussion. This way,
they were on their best behavior to get up there and try to say
something, so the others couldn't demolish it.
Crawford: You had more Ph.D. degree students, I think, than anybody on
the faculty.
Blum: I probably did.
Crawford: Were you tough?
Blum: No, not at all. I'd inherited a good many from other faculty
who seemed not to care; wouldn't even read their students'
papers. We had a few such faculty. I got four or five very
good students who had a faculty member who wouldn't even read
or criticize their thesis. I remember three or four—at least
two of whom are now professors — that I just took over. I said,
"Let's change the committee structure, and I'll be your
chairman, and let's get rid of this knothead that you've got in
there as your committee chair."
251
Crawford: You mean they'd sign off without having looking at the thesis?
Blum: Well, they might not even sign off. They might not ever do
anything—it was just horrible. There weren't a lot of such
people, but there were a couple, and they were in interesting
slots, so the students were attracted to them. That was kind
of tragic.
Crawford: They were there for research instead of teaching?
Blum: They weren't there for anything.
Crawford: Just lazy?
Blum: Lazy was the only word for it.
Crawford: But a small percentage, let's hope.
Blum: Yes, but they were agreeable — they ' d take any student. But
then they wouldn't even read a thesis.
I inherited a lot of ambitious people who came in with an
anthropologic, sociologic, or economic kind of slant, a lot of
whom weren't mine. When I retired, I had fourteen people,
still, in the Ph.D. track. That was fine. That kept me doing
something for several years. They took three, four, five
years. Many of them were working full-time as well.
Crawford: So that's a very rewarding aspect — it has to be.
Blum: Yes, and people don't appreciate that. I heard the old saw
about faculty who have to publish or perish, but that never
bothered me as I started out at the top, and within a year or
two I was tenured. As I've said, I was lucky.
Crawford: You never felt pressured.
Blum: Pressured? No.
Crawford: You published lots after that, obviously.
Blum: Not a great deal. I should have done a lot more. I've got a
lot of things I really could have published, but I wasn't quite
secure about the validity of my observations, for instance,
after my study of Sweden in 1986. I did more work on Sweden
than anybody's ever done from this country. I didn't publish
it because I knew there were a lot of weak spots in what I had
put together, things that no one in Sweden was prepared to
argue or defend. It was good enough for me to use as the basis
252
Crawford:
Blum:
Crawford;
Blum:
of lectures and classes, but we weren't drawing absolute
conclusions, and I was too lazy to do the research on the
thing, especially knowing that a stranger does see things
differently, not necessarily correctly or wrongly.
This was true of my trip to China in 1987. I had just
finished reading, when you came in, a thesis on health care in
China. It's exactly what I observed in 1987 as a visiting
professor at West China University of Medical Sciences in
Chengdu, but I never wrote a word on it, because I thought that
although I was there three months, I had pretty superficial
information. I didn't really document, and of course, neither
did they. I was just wandering around, looking, talking, and
as it turns out, as better documentation is emerging, I was
very much on the right track with my surmises, e.g., that
useful basic care for the rural 800 million was falling apart.
Well, this is a masters thesis I am reading, done from the
literature, but it's exactly what I had discovered. It's as I
thought it was--one hell of a mess, and it all started just
about the time we were there. I never published a word on it,
because I didn't want to badmouth China. I didn't know where
Deng was taking them. I wasn't about to spend a year or two
researching that. Besides, I don't speak Chinese, I don't read
Chinese, and so it would be a lot of second-hand material. I
just didn't bother—but in my own mind, I saw it very clearly.
In the Swedish situation I did report about what went on in
Sweden, and contrasted it with what is going on in the U.S. so
that American readers would have a baseline—but never
published it.
Yes, we have that material.
I think it was pretty good, but I wasn't that interested in
publishing. I didn't have to get ahead. I did it for my own
edification and for the students that I was working with. That
was good enough, but some of the faculty feel so pressured.
These are even people who have tenure and the luxury of
everything—if you can call it luxury, being around here. They
really weren't interested in students; that's what it all
boiled down to, they were into research.
You often hear that.
The one thing that I could see was that if I gave three hours,
three times a year— which is not a lot— to some good doctoral
student, that's about what it took to help them when they
needed it on their thesis, I could learn a lot.
253
Crawford: Your door is always open, even now. Dr. Reeves told me that.
Blum: Yes. But that is not expensive. I mean, three hours once in a
while for somebody digesting the world's literature on a
subject and doing a study on some aspect of an issue gives you
the last word delivered to your desk. Nobody's going to do it
any better. It's usually something new, and if it isn't
something new, it's a repeat of something old that needs
repetition. You can't complain that you're losing ground--
you're not.
Crawford: Your gain.
Blum: Yes, for a few hours, you get what people have spent hundreds
and even thousands of hours on. It's true that many faculty
who do work with graduate students only let them work on the
area that they themselves are working in, and this
distinguished me--I was willing to have the student work in
whatever area if it's relevant to the student, even if I'm not
getting ahead from it.
Crawford: You'll get better material if it's their real interest they are
researching and writing about.
Blum: Well, surely, yes, but these are different ways of looking at
it. In part, I never had any pressure. My wife and I had
always said we weren't going to bend to pressure, so we always
saw to it that we didn't have great debts and we always had
some money in the bank. We always paid for our houses when we
walked in the door. We were not born rich, I can assure you,
or even well-off or even just minimally well-off; we were in
real trouble economically, but we said, "We're never going to
be pushed by our debts. So we don't have to accept anything
from anybody that we don't want to." And that's a great
relief. Now it does mean that you're stodgy, in one sense,
that you always want to have a bank account, but I don't find
that so embarrassing.
But I learned a lot and I took fourteen or so Ph.D.'s on
after I retired.
When I retired from the School of Public Health at the end
of 1984, there was a huge party--! mean, hundreds of people
from all over, and there's a picture of me, six months old- -my
wife had fetched it out- -stark naked, you know. [laughs]
Crawford: Oh, they loved that.
254
Blum: And they blew it up. It was six feet high. I found it the
other day, or she did, cleaning out my study closet.
So it was that sort of a thing; my whole career laid out,
and people wanted to say things. The major speaker was Bill
Reeves, but Lucy Johns wasn't on the list to say anything, and
she just worked herself right up to the microphone, and got a
little hysterical—that's not Lucy's style—about how I'd saved
her life, and her career, and a few other things. She was one
of the protesters in '67, in that first class. Lucy had
wandered around with some kind of a sign about something or
other, and lo and behold, had been nailed and, apparently,
kicked out by Chuck Smith. I don't really remember all this,
neither does Bill Reeves.
Crawford: That was the situation on campus?
Blum: Oh, it was pretty mean, yes. I found out whatever the matter
was and got her back in. She was probably the best student I
had. It was just absolutely an amazing planning class, almost
every one of them became well-known at whatever they were
doing.
That was a class that insisted that we teach planning
because they all came for that purpose, but there was no
planning program or courses as yet, and it was my first year of
full-time teaching. So we struck up a deal. There were about
thirty students who wanted to take planning, and, if each of
them promised to do a lecture, then I would run the course. I
agreed to give one lecture too. We had divvied up issues of
different kinds that none of us knew about, because planning is
not the public health world. It wasn't then, and it still
isn' t .
Crawford: So the demand was coming from the students?
Blum: Yes. As I said, I was hired as a professor of administration,
and at that moment they didn't need me in that area. They had
several good people here, and there was nothing left for me to
teach, so I was going to sit. I remember coming to the first
faculty meeting, and they asked, "What do you want to do?" I
said, "There will be a planning law in a couple of months- -
maybe I should teach planning." They agreed that it was a good
idea. They said, "There's nobody here to teach planning, and,
besides, everybody in public health knows how to plan." Which
was surely a good joke, as it turned out. So I agreed to do
it, and I had this first class, which probably was January of
'67, and Lucy was in that group, along with some other
unbelievable people.
255
Crawford:
Blum:
Crawford:
I had been to a meeting a few months before the course
started and ran into a man by the name of Mark Blumberg, who
became chief planner for Kaiser. He was probably the first
bonafide health planner in the United States. Mark Blumberg- -
he was a dentist, a physician, and an economist — and just a
tremendous person. He did some of the first technical health
planning in the U.S., in Hawaii on their health plan, and put
them way ahead of everybody. Nobody knew what it was that he
was doing at that time, but it was good, and became a landmark
approach to one area of planning.
I think he and I had worked together at that air pollution
control district — that little advisory committee— and Mark was
either part of the staff, or he was on the technical advisory
board. I left about the time he came on. Maybe he replaced
me . I don ' t know .
A few months before my first planning course got underway,
he and I were at a meeting on manpower, and he gave a spiel
about what was wrong with the document that had been presented
to us. I had exactly the same feelings about it, and expressed
them. After that, he came up to me, and he said, "What the
hell do you know about planning?" He's that kind of a guy, a
really big, tall gruff guy. I said, "Oh, enough to be a
professor of health planning." He had never been a professor,
and I'm told that he always wanted to be, and that remark was
the worst kind of beating anybody could have given him. He's a
very helpful man, as well as a wonderful planner.
So, since we were getting acquainted the hard way, I said
to him, "Look, I'm going to start teaching a course on health
planning. How about you coming over and opening it up, and
setting us straight. Explain planning to us, because I'm not
so sure we know what it's about." He did that and came here
for years. He used to assist, come in, wouldn't take any
money. He was at Kaiser and couldn't receive money. Mark
started us off, and then each of the students took a subject; I
took one, and we explained to one another what these terms and
concepts were that were central to planning and that we had
never dealt with in public health. So the course started out
with a bang.
What was the thrust of the course?
Planning— health planning- -what it was, how to do it. It ended
up being a great big book in my hands before it was all done.
Different kinds of health planning?
that sort of thing?
Single payer coverage,
256
Blum: No. We were in the world of health planning, not health care.
My attitude was that you have to plan for health care when you
fail on the health planning side, that what doctors do is just
treatment for health failures.
Health planning really has something to do with "Do you
have something to eat? Do you have a job? Do you have a roof
over your head? Do you have rats enjoying it with you, or
not?" This is what affects health; this is the big game. The
world is coming back to it, finally. The realities are that
health is determined primarily by the large environment,
social, cultural, economic, educational forces in particular.
So that's what the students were learning. Ultimately many of
them ended up doing health care planning too.
Crawford: What was the legislation?
Blum: Oh, it was the Public Law 89-749--the 89th Congress.
Crawford: You said that became law just as you were coming on at
Berkeley.
A 1968 Planning Grant from the USPHS ; a Program for Minorities
and Native Americans; Abandoning Our Marvelous Planning Grant
Blum: Yes. We knew it was going to happen, and nobody in the United
States or anywhere else knew where or how to start teaching
about it. So we started right here, and we had a good time.
We got a huge grant—Bill Reeves was already dean--and we
started out educating ourselves.
Blum: In the School of Public Health we did assemble a team. It was
very clear where the health problems were — they were primarily
in the poor and dysfunctional neighborhoods. So we started the
planning program here by bringing in forty or fifty of the
world's top planners in the summer of 1968 to teach us what
planning was and how to go about it.
One of them came from Cleveland, which supposedly had done
the very best work on health planning. They have a good school
of planning in Ohio, interestingly enough. I think it's the
Hoover School at the University of Cincinnati. I remember I
visited there once. Cleveland had this great study about what
to do, and if you flip over the pages of the report, the first
257
thing you see is where the problems are. The problem areas
were shown in transparencies, and on the very bottom
transparency was the census tracts. On the next overlay
transparency was the average incomes. Then came all the health
pictures. All the bad health problems in Cleveland, by and
large, were in a handful of neighborhoods; you could see
through all these transparencies — all were in the same place.
Cleveland had brought in the greatest minds in public
health and that was part of this great Cleveland Plan. They
looked at the study and they said, "Well, we have to have
better sex education. We have to have more blood testing."
They looked at the infant death rates, and they said, "We have
to have more clinics to give earlier prenatal care." All in
the bad neighborhoods.
They went through every one of these major health
deficiencies and came up with all the answers that never have
worked- -and that was the great Cleveland Plan. We learned how
incompetent health planners really were and how ignorant public
health specialists were.
Crawford: What is the problem with it?
Blum: The study tells you exactly what's wrong, and that nobody gives
a damn about the causes. They went through all the traditional
markers for health and produced all the recommendations that
don't make that much difference. They acted as though treating
each of the findings by traditional health care and education
was going to offset the illiterate, poverty-stricken,
dysfunctional neighborhoods and families.
Crawford: Instead of getting to the neighborhoods--.
Blum: And seeing how you could revive them. But we were educating
ourselves, and that's when we invited all these people in, and
it was kind of dispiriting to see how stupid some of the
renowned experts really were. None of the professional
planners were making a case for looking at anything
intelligently. The Cleveland Plan was great — tremendous, but
it was irrelevant. Even heart disease, even cancer, accidents,
all diseases were excessive in the same neighborhoods, how can
one overlook the socio-economic cultural setting?
Well, people are still getting famous for writing about
that and using those data— some to illustrate what is really
relevant, and some to go back to the old garbage. The United
States Public Health Service still deals mostly with the old
garbage— even the Robert Wood Johnson Foundation in one of
258
their 1997 brochures regurgitates how it's just bad habits that
are killing Americans.
II
Blum: As an aside, there had been practically no minority students
here before that. Yes, there were people who were black or
blue or green, but that's because they came from other
countries to get their schooling here.
So we started out, and one of the people in that first
class was an exec from the TB circuit, Elaine Walbrook. She
was in my first class when I was new here, and she was new as a
student, but we had become old pals in previous years. Since
I'd lost track of her in the TB movement, she had gone to work
for the Paiute Indians in Nevada. She was in the class, and as
we put the grant together I grabbed her to be part of the staff
because she was an expert organizer.
Crawford: This was a U.S. Public Health Service grant in curriculum
planning?
Blum: A planning grant.
Crawford: A hundred and six thousand, something like that?
Blum: Oh, hell no. It was a million and a half or something like
that.
Crawford: For Berkeley? That's astounding.
Blum: Well, there was no school in the country that was prepared to
deal with it but Berkeley's School of Public Health.
Crawford: Those were the salad days?
Blum: Yes, there was money. Lots of money has been wasted on a lot
of other things, too.
Crawford: Was that a multi-year grant?
Blum: Yes, it was for three years. Elaine had the idea to bring in
minorities in the summertime for the six-week summer portion of
the grant program and teach them something about health
planning. We decided to bring in a lot of black people for the
first summer, because they were the most numerous around us.
Then the second year, we would bring in a good number of
American Indians—who were her buddies — and she knew their
world backwards and forwards. The third year, we would bring
259
Crawford:
Blum:
in Hispanics--they ' re the most recent immigrants,
exactly what we did.
And that ' s
We had a tremendous experience, and not just because we
brought in guest lecturers. We started in the spring of '68
with ourselves and guest artists for us, and by the time we got
to the summer, we realized that we were hearing nothing new,
practically. Everything we were going to hear, we'd boned up
on. In a year I'd read about three hundred books on planning--
I really mowed through the field. I discovered that we in
public health knew nothing about it. The planning that one
does in administering an organization has little to do with
community- level planning. It's a different world.
Define what you mean a little more narrowly, would you?
Well, if you work inside an organization, you've got the
organization's objectives, and you've got the rules of the game
by which it must work, and a set budget with which to do it.
This is what is wanted from it, so how do we get from here to
there with the monies we have,
almost automatic.
It's internal planning. It's
Crawford:
Blum:
In other words, that's what everybody is getting so famous
for, guiding their organization, and getting their hundred
million dollars of bonus for. You're going from here to there,
but you have to figure out how to do it- -but it's all cut and
dried when it's within your organization, e.g., make a handsome
profit. Once you make your plan, whether you were wise or not,
time will tell. But when we were doing health planning, we
were planning for whole communities rather than for an
organization, and we had to take everyone's objectives into
account, various levels and types of government agencies and
the whole world of private interests, as well as the
unexpressed needs and desires of the citizenry whose health is
to be improved.
Global.
Yes, in other words, what is needed here? This is a view that
can be shared by every citizen, if you want to go that far.
There is also a special set of constraints, as no two people
need or want the same things. It's just a different world—and
it's a fun world—it isn't just internal organizational
planning. Not everybody understood this, and some people in
public health never did.
So we started out teaching ourselves, and within six
months' time, we had a pretty good understanding of the
260
subject. Then we invited in these minority people, along with
others, for a six- week summer session. We had folks from all
kinds of out-of-the-way places, such as the Pacific Islands.
We brought in lots of minority people who ultimately went on to
graduate school, and a good many for more advanced degrees.
They had been proposed by their communities generally.
II
Blum: Unfortunately, our concern for planning for improved health did
not focus on how to do more or better medical care, rather on
how to improve health by working on the socioeconomic and other
factors that determine health. This scared our funders. At
the end of the second year they adjourned a spectacular team of
over a dozen hot-shots of traditional fame. After a day of
questions and answers down in the then Regents' meeting room on
the ground floor of this building, they remained totally
nonplussed, best expressed by one of the visiting geniuses,
"Why don't you build something useful like planning a health
center, rather than working on how to prevent the various major
forms of heart disease?" I lost my cool and suggested that
we'd rather use our wits and no money than their wits and their
money, a sort of Shavian take-off.
As we walked out, someone came up behind me. It was Bill
Reeves, whom I hadn't seen come in the back door, and he said,
"I guess you don't really want your grant — good for you, keep
on doing what needs to be done." That was mighty supportive
from the dean at a bad time.
We had done the right thing and went on our way. They let
us spend what remained of the grant.
Blum: Planning became big time, even without our grant, and Elaine
Walbrook, because she identified with the Indians, took their
recruitment on after the big grant was over, and we really
brought in Native Americans to UCB for years and years and
years; brought them in first to Public Health and to Social
Welfare, then to the whole campus. Elaine was the brain behind
this.
When you come to our house, you see a lot of Indian things.
These are gifts from ex-students; people that went through the
program. They had an interesting time. I remember one lady,
Sandra Yellowhawk, gave me a beautiful burden basket. She's an
organizer, down in Peach Springs, of all places — that ' s the
entryway to Havasu Canyon. She was a very quiet, soft-spoken
261
person—trained as a nurse. After the first year—it was a
two-year program— she introduced me to her husband and daughter
one day, and she said, "I know you wouldn't approve of what we
did, but my daughter and I just went to"— what was the name of
that great big faker who held those horrible meetings and
taught you how to be a bastard to everybody?
Crawford: Werner Erhardt— est .
Blum: Werner Erhardt— est . She said, "I know you wouldn't approve of
it, but we went." She never spoke like this before. She said,
"You know, I don't think my daughter and I ever had a
conversation before we went to this course, and my husband and
I surely never did. We just sat there and ate our breakfast,
and our lunch, and our dinner. We never really conversed with
one another. Now we do." She joined the graduation committee
of the School of Public Health, and she got into every single
thing before the year was over— she just blossomed.
Crawford: She was empowered, as they say.
Blum: Empowered. And by that reprobate. Well, we had all kinds of
people, and some did have trouble. We brought in a wonderful
old medicine man, and he had a bad time because this was so
foreign, and he was an old man. Many of these people, when
they went back to their tribes, were resented and pushed out.
It was like the old story of the Africans going back to
Liberia: "We don't need you; you're not one of us." So there
was some of that.
We had one wonderful guy, since passed away, who was a
robust Midwest Indian. He was a fighter pilot during World War
II, and a hereditary chief. Some of the tribes have hereditary
chiefs, some have elected chiefs, and some don't have chiefs at
all, like the Navajos. He came through the summer training
program, and he did very well, though he used to give us a
rough time. He was a burly, fun kind of character.
Elaine set up an Indian advisory board for the whole Indian
recruitment and training program that we ran. All this had
merged, finally, into just an Indian program, because black
recruitment and Hispanic took place elsewhere. The advisory
board was made up of prominent Indian leaders from many walks
of life, including some of our former summer trainees as well
as Indian graduates from our school. They advised us on the
real world, on what we had to teach, and helped get legislation
and funds relevant to our training and relevant to Indian
health generally.
262
Crawford:
Blum:
The hereditary chief came on the board a few years along,
and as I greeted him he made a little speech to the board for
my benefit to the effect that I had been so patronizing to the
Indians in the summer program, and it made him decide to show
me--he went to Harvard and got an M.B.A., and then went back to
his tribal chief duties, and here he was on our board, back at
UCB. He had forgiven me, decided I was all right after all.
Elaine did so well that we recruited Indians for eight
other schools of public health, as well as our own. We'd give
the trainees a summer training here, and then they'd go to
whatever school they had chosen. We had big grants in order to
keep going. Elaine did all that single-handed. She knew
Senator Fred Harris, who was married to a great Indian lady.
Elaine really knew everybody in the field and on the
congressional committees.
Then the Indian Health Service started fighting us. You
see, we had said we would not train people just to go back to
the Indian Health Service. There was no way Indians were going
to get a masters degree here and just qualify for the Indian
Health Service. You come here as an Indian, you're not going
out as an Indian- -you1 re going out as any damn thing you want.
They couldn't understand that, and they didn't want to put
money into it. One of the SPH non-Indian graduates, actually,
ran the IHS program. We fought him tooth and nail in Congress
and won, year after year. Elaine was hated in some quarters,
but she did the job and was loved in the Indian community.
Were they generally successful in their fields?
I would think so, yes, and we have some wonderful memories of
some of those people, some of whom I still occasionally see.
The upshot of all of this was that we won the battle year
after year of getting the funds for the Indians, in spite of
the Indian Health Service. Elaine passed away a few years ago
from cancer, which had limited her for several years, but she
never quit. She carried the ball on this campus.
We had social welfare involved, and then we sat down with
the dean for minority affairs and the folks in engineering;
some petroleum types. They said they didn't want any Indian
programs, unless the students could get in on the usual
admission procedures, and so on.
Elaine looked at this great professor, and she said, "Where
do you work? Don't you work with Conoco? Do you know you're
on Navajo land? Do you realize that they govern this land?"
263
She really slapped him around, and, lo and behold, engineering
decided they could take Indians. Some of the students
graduated here and then went through law school as well.
There was another Indian graduate of this school of public
health years and years ago—Blue Spruce. George Blue Spruce
was an Indian dentist, of which there are very few, and he had
graduated here and had gone on to be a big shot in the Indian
Health Service. Such Indians were rare until our program
kicked in.
I hadn't been here very long when I got the bug that we
should have minority students in the department. In Contra
Costa County, we had worked with all kinds of wonderful
minorities. There were people who were talented, yet said that
they could never make it into this university and so on. It
seemed preposterous, but many of them didn't bother studying in
school, and I knew that. So I cooked up a deal.
I wanted nineteen or twenty new student slots, one for each
program—there were that many programs in the School of Public
Health, and everybody who had a grant had a program. They were
departments unto themselves, and it was a mess.
Crawford: What would have been some of those categories?
Blum: Oh, there might be maternal and child health, there might be
nutrition—those are the big ones— health education, but then
there was nursing administration, there was hospital
administration, there was dental administration, there was
general administration, there was planning. There were five
programs, right in that one little enclave of administrative
thinking, each admitting their own students.
Crawford: All competing for the same funding?
Blum: Not quite; there was different funding. The reason they were
in existence was that each had different specialized funding.
This was the heyday of the School of Public Health fundings,
but not too academically healthy.
Crawford: Why was funding so easy to come by?
Blum: Well, this was the Johnson era. They were trying to do
something, trying to change. After all, the U.S. was a pretty
chronically impoverished place. It may have looked good in San
Francisco, but it didn't look so good in a lot of other places,
including the hills of California. Hillbillies were indigenous
out there, all kinds of them.
264
Crawford;
Blum:
Crawford:
Blum:
Crawford:
Blum:
Crawford:
Blum:
So I decided to go for a minority training grant. I wrote
it up and took it around to each of the faculty, and I said,
"Just put up one slot. Make a provision for one student, one
minority, and between us, we'll have twenty." Do you know, not
a single department would give me one slot.
A student slot?
A student slot,
was one.
Not a single department except mine, so there
What would it have cost them?
Nothing, they just weren't about to put up with that kind of
nonsense. They were going to pick all the best students they
could get, and had no room for a minority person who might not
seem up to the grade-based competition.
So, was this anti-affirmative action?
Oh, yes, and I realized it wasn't going to get any better.
How about Dr. Reeves?
Well, he was the dean, so I took it down to him. I'd never
talked to him about this, and I didn't know what to expect. I
knew he was a nice guy, and I knew he liked me because he was
the one who made me a tenured professor. In those days there
were no committees—you just did it.
He said, "You're going to take in nineteen or twenty people
because they're black or brown or something, and you're going
to leave out people with straight A's from Harvard?" I said,
"I don't expect to leave anybody out who has straight A's from
Harvard, but it might be good for the school to leave them
out." We had had some horrible people from those great places.
I said, "These are the people who come from the ranks of
the folks who need the services, and we graduate nobody to talk
to them out there." This is a very basic argument about
diversification. We had quite a time, and then, without
batting an eyelash—typical Bill Reeves--he said, "All right.
What do you want me to sign?" [laughter]
So he signed the document asking for the assignment of
nineteen or twenty new student positions in the school,
positions which are fought over because student slots are the
basis for getting more faculty—it 's all geared to student
enrollment, you see.
265
Then I took this up to the dean of the graduate school, who
I've mentioned was a fine man by the name of Sanford Elberg.
Sanford is still around. He used to be faculty at the School
of Public Health. He was the world's authority on brucellosis.
He had been one of my instructors in bacteriology; we hit
it off really well, because I had made a point of being the
best student in the big course in bacteriology.
fl
Blum: He looked at the document and agreed that it was very
important. He said, "Let's go into the inner office and talk
about it." Then he gets to the inner office, which was all
fitted in oak, pulls open the drawer behind him, and brings out
a big flask of sherry. He pours me a glass and pours himself a
glass. [laughs] This isn't customary behavior on this campus,
I'll tell you.
We start discussing the proposal, and we go through the
various aspects of it. I wanted these graduate level slots to
be free of the college B-average requirements, so that the
students could come in with less than a B average if they met
certain other criteria.
Crawford;
Blum:
He said, "Well, I'll take it under advisement." I knew it
was probably like birth control in the health department — it
ain't done. You just don't ever drop the B average for
minorities, which you do all the time for football players and
basketball players, artists and others, and, I suspect,
occasionally for the governor's son or daughter, but I don't
know that. I have just heard more about this recently.
I get a letter a week or so later in which Sanford starts
out by indicating one of the problems with it, and then another
problem, then another problem, and another. I thought he was
going to let me down—the usual university stuff—and then in
the very last paragraph he says, "However, this is such an
important experiment that you are hereby authorized the
nineteen new positions for graduate students."
This caused concern amongst the faculty?
No, no. They didn't mind if they got new slots so long as they
didn't have to set anyone else aside. They'd take a chance.
Crawford: They just didn't want to give up their own places?
266
Blum: Anything. I mean, real academic pigs. I hate to say it, but
I'm not impressed with academia's sense of social justice.
Crawford: Was there a lot of infighting amongst them?
Blum: Always. Academia is a world of great claims. It's not
necessarily a world of great performance. My biggest
disappointment in the university was its pretentiousness.
But I just took the bull by the horns, and what I did was
business as usual, I guess. I short-circuited everybody- -went
to the dean, went to the graduate division—and got the slots.
One of the least sympathetic program heads came charging in
as soon as the new slots were announced, demanding two or three
of the slots or they would raise a stink about the program.
At that time, my office was down on the corner where Copy
Central is now. The planning project was in that building,
over a Bill's Drugstore. We were upstairs in a real dump,
sitting in pigeon droppings; the windows were open half the
time. I said, "Do you see that door right out there? I'm
asking you to get out of here and never come back through that
door again. I never want to talk to you. You think you're
going to blackmail me? Just start right out."
At that point, I was chairman of the department, and I
never did talk to this person, a caricature of an academic,
again for years. We didn't hear any more about blackmail.
Blum: Going back to minority students, the first class we brought in
of about twenty or so included a black woman who had very
mediocre grades — a C+ average--f rom some college in the Valley.
She got through with us, got her masters degree, went on and
got a Ph.D. in political science at UCB. That's a student who
didn't have a B average. Political science has got to be one
of the weightiest departments on this campus. She was a
wonderful woman, and along the way she even did organizing in
Botswana.
We had a lot of interesting people who came in under those
slots. We didn't count Asians or Jews as minorities; they're
not a minority in this field. We would be inclined to take in
an Italian because they're so rare—not anymore, hopefully, but
they were.
267
So we took in these people on our special slots, mostly
blacks and Hispanics, as it turned out. Through our planning
grant we had recruited many of these people in the summer
before to come and look at the university and see what there
was , and many of them came back in planning or in health
education. They usually had weak backgrounds in science, so
that math and statistics and epidemiology would not be their
first home. They would be going into something like health
education or administration, which made sense, and had
infinitely more social emphasis and relevancy for them.
That girl I mentioned had organized a clinic for a black
community when she was in high school. So who needs B's--we
can't get people with A's to do that for a black community. We
did take in a few minorities with high averages who weren't
worth a damn, just like whites who had never done anything.
Book learning isn't where it is — it's part of it, but it's not
everything in this field.
So, it was very much fun, and the Indian recruitment went
on and on, and the minority recruitment went on for a long
time, and is supposedly still going on. We set up a faculty
committee, yet very few of them would even come to the
committee meetings. I can name two or three that did. The
rest of the faculty wouldn't even give the time of day to such
efforts, which of course gave them very little tangible
rewards. They were getting ahead; no time to waste. They're
getting themselves ahead, to be specific.
Pressure to Publish. Public Administration, and Alex Meiklejohn
Crawford:
Blum:
Crawford;
Blum:
How would somebody like that unsympathetic program head be
tenured in a department like this one?
Write a book every year, write a paper every week, and usually
get somebody else to do it, or it's a compendium of opinions.
I'm not impressed with such garbage. It's easy work and
doesn't take any brains to do it, but you publish, and it gets
you in all the best places.
You said you didn't feel the pressure to publish.
I didn't, because I came here at the top of the ladder and was
soon tenured. I wasn't the first year, but I was tenured
shortly thereafter. I'd already done my vision study—the
268
Orinda Vision Study—that was a classic operation. Then the
book on administration was pretty fancy stuff. It would be
fancier today, sad to say. Blum and Leonard, 1963, as I
mentioned. That was Public Administration; A Public Health
Viewpoint.
It was dedicated to Alex Meiklejohn because I had really
understood through him, finally, what public administration was
about. It has something to do with the country's philosophy,
its people, and its history. I never understood that when I
went to Harvard and supposedly learned administration. I
thought it was something like physics or math, something very
tangible, teachable, and comprehensible. But administration is
purely an artifact of a culture, and I commenced to realize why
administration changed every five or ten years—because the
culture was changing. Everybody was catching on a piece at a
time. So the book was devoted to that.
Alex Meiklejohn lived here in Berkeley, and one day Al and
I invited him and his wife to our house. We lived in Walnut
Creek. And Alex, his wife, the Leonards, and we had lunch.
Marian, my wife, made a very lovely luncheon, and it was a
beautiful day, and kind of open to the backyard. We had a nice
place out there.
At the end of the lunch, we said to Meiklejohn, who was
approaching ninety, "We have a surprise. Here's a copy of a
book for you that was dedicated to you." His wife and he were
sitting side by side on the sofa after lunch, and he said, "My
dear, isn't that exciting." He was very soft spoken, and spoke
very little. He was a famous man, and revered in educational
circles--at Amherst--the leader who started that whole new
movement in college education. He looked at his dedication; it
was short and sweet, and then he suddenly looked at his wife
with consternation, and said, "Oh, my dear, do you remember
there was another book that was dedicated to me. It was so
terrible." [laughs] That was Alex Meiklejohn. He wasn't
going to disguise his sudden remembrance of comparable things
gone wrong in the past.
One day his wife invited us to a Bay Area Planned
Parenthood annual meeting where Gertrude Jones, a world-
renowned Planned Parenthood gynecologist from the Midwest, was
going to give the lecture. We all went to Meikle John's house
for dinner. It was Jones and her husband, and Dr. and Mrs.
Meiklejohn, and my wife and I, sitting together in their house
right up here on La Loma in a nice, big comfortable dining
room. Jones's husband was a corn farmer from Iowa--do you
remember Khrushchev visiting a corn farm in Iowa? He was the
269
Crawford:
Blum:
brother of that corn fanner; a husky guy with a big, open face
--kind of a match for Khrushchev, I'm sure.
We're eating dinner, and we're getting ready to go to this
meeting, and he says to Meiklejohn, "Alex, how do you feel
about all this family planning?" Alex, his eyes twinkling as
usual, said, "Well, I'll tell you—I'm a ninth son."
[laughter] Wasn't that wonderful? This is a man of few words
and lots of thought. I thought that was magnificent.
He wasn't a great proponent of family planning.
Well, he probably was, but give or take a few kids. [laughs]
Building a Planning Faculty
Crawford;
Blum:
Good story,
this point.
Well, we should talk about the planning faculty at
I had to build up a planning faculty, I started recruiting
people. I recruited some very, very interesting people, and
some of them were tenured appointments; some were not.
Alan Blackman I found at City and Regional Planning, where
I taught briefly and got to know most of the faculty. He was a
fellow who'd gone through Reed College in Oregon, which has a
peculiar reputation. It is fantastically full of brilliant
people, and by my standards, full of impractical folks at the
same time. He was one of their grads, and he couldn't quite
get organized to get his doctorate, but he was smart, smart,
and he knew the planning field. So I hired him on the grant
for the first year, and I'll never forget, he's setting up the
summer course, and it looks to me like all the big shot guest
lecturers are lecturing on Sundays.
I said, "Alan, I don't see this business of putting people
on Sunday. That doesn't sound like good planning to me." He
gets his calendar out, and we're looking and comparing the
dates on this little chart. It turns out he'd gone to a yard
sale, and he'd bought this beautiful calendar, but it was last
year's calendar. Somehow I always held this against Reed. I'd
had dealings with Reed students here before in bacteriology,
[laughter]
270
Crawford;
Blum:
We had our problems, and I had to fire him, but he was a
bright man. I learned a lot from him. Everybody we hired had
something to teach us.
I brought in Cy Roseman, who eventually left his tenured
position here—got sick of it. He was a tenured prof in health
planning and administration. And Dick Bailey, who retired just
a year or so ago, was an economist and very useful to us. He
did a couple of beautiful books based on some research that
almost fouled his own nest.
He was applying for tenure, and he did a book on economies
of scale in health care in which he interviewed, visited, and
studied the records of a great number of physicians to see how
much work they really did, how many patients they saw, and
where the time and effort went; he discovered that groups of
three or four doctors were the most efficient. Everybody knew
that was wrong, so when he came up for tenure, folks in the
economics department said, "This is primary data. Who can be
so stupid as to waste time getting primary data?" Meaning, you
went to the source of where it really is, not statistical
sources or secondary data which always prove that it's more
economical to have large groups.
Well, large groups are economical in one sense, they make
more money per doctor, but that is because they have drugstores
sell drugs, all sorts of goodies, and that's where they really
make their killing; but they do less work as doctors. They are
not more but less efficient at doctoring in larger groups.
In delivery of care?
In delivery of care. So we had quite a knock-down, drag-out,
and I really pulled out all the stops as chairman of the
Department of Social and Administrative Health Sciences, one of
the two departments that made up the School of Public Health
after the smaller programs had been merged, to have him
redeemed for getting primary data, when any jackass can go get
secondary data, which, of course, in this case isn't measuring
effectively at all. It doesn't tell you what you want to know.
So we won that battle, and he got his tenure.
Crawford: You were chairman of the Department of Social and
Administrative Health Sciences, known as Department A.
Blum: Yes. Under Bill Reeves the faculty divided the school into
two. Parts of each department, however, couldn't stand one
271
another, so it could have been better, but I think that the new
dean, Pat Buffler, has done better by it recently.
But public health is always going to be uncomfortable to
subdivide. It's just like a hospital. You've got a nursing
division that does work all through all areas, but then you've
got housekeeping, that does similarly, and you've got pharmacy,
and then x-ray, run by doctors, other services that serve all
the departments, as personnel, or [production?] and so on.
Crawford: Not tidy.
Blum: It's a three-way matrix. I mean, this way and this way and
that way. You're constantly stirring around. The only person
I ever knew who worked that out very well was a man by the name
of Bob Biller, who went on to be provost at USC. He was in
political science and was the first head of Health and Medical
Sciences here, and he had worked this out — this matrix—the
difference in why you go one way one time and another way
another time; he put some sense into it. But there are always
problems with organizing public health because there are too
many disciplines and too many subjects and too many kinds of
students.
Crawford: What has Dean Buffler done?
Blum: She reorganized the school in a new way, in that faculty have
to establish a home in one or another of five divisions,
irrespective of what their own background is. These divisions
are more nearly related to traditional subjects like
environment, administrative sciences, epidemiology. But if you
want to do something with AIDS, that wouldn't necessarily be
just in epidemiology or contagious diseases--it could and
should include folks from sociology or maternal and child
health, it is a cross-cutting area of interest. Thus the
traditional areas are joined together by these various problem
areas—back to Leonard Duhl's old theory that if you had a
significant problem, no one discipline was going to be able to
take care of it. This actually sets the stage for urging
people from different disciplines to get together and work
together. The work that you do commences to relate you across
the board, not just in the School of Public Health, but to
other colleges and other schools. These cross-cutting entities
may come and go as special problems or issues come into being
or retreat.
Crawford: So it encourages a kind of fluidity?
272
Blum: Yes, without disrupting the basic departments, which are then
crosscut by people doing different things.
Serving on Committees of the Academic Senate
Crawford:
Blum:
Crawford:
Blum:
Crawford:
Blum:
Was the faculty loaded down with administrative chores?
Yes, to quite an extent. This university had undertaken to
have a weak formal administration, and the faculty had to do
the thinking and much of the administering, which is the
trademark of this university.
Is this different from Stanford?
To a certain extent, yes. There's much more faculty
involvement in running the UC system. The first great revolt,
in fact, was here in Berkeley in the twenties, and it was about
having the faculty run the university. When you do that,
you've got to undertake to do a lot of things, and the Academic
Senate is a monstrous bit of machinery.
When I first came here, I thought I'd better learn
something about teaching. Having only taught off and on for a
decade or two elsewhere, I found I knew nothing about teaching.
So I joined two committees of the Academic Senate; the two most
preposterous committees, I think, that ever existed. They're
still here, still doing their good work—the course committee
and the teaching committee.
Everybody on the teaching committee, obviously, was headed
for winning a teaching prize. The only thing they did was give
out teaching prizes. That bugged me right off, because you
know that teaching is often a gift. It comes with certain
personalities .
Did it come easily to you?
teacher.
I know you're a very popular
Oh, yes. But at the first meeting of the Academic Senate that
I attended, they announced they're reestablishing the teaching
committee, and they would give five prizes every year to the
best teachers.
They also told us that the last time this committee did its
work, three years before, and nominated five people, every one
of those five people were fired that year, and that that was
273
very, very unflattering to the university. So they wanted to
have the committee pick people who wouldn't be fired. In other
words, the fact that they are superb teachers isn't worth very
much around here. This is the first lesson I learned after I
arrived.
Crawford: How do you measure a teacher's qualities?
Blum: How do you measure? By a mixture of popularity — students
saying this is a fantastic course, the best course I ever had —
and opinions of other faculty, too. So we picked out five
people, and cleared each of them with their departments, that
they weren't to be fired- -how do you like that?
I started objecting pretty early. There was one fine
person on the committee, and that's Marian Diamond. She's not
only a magnificent teacher and researcher, she's a good human
being. Everybody else there, I'm sure, was bucking for a
prize, and they all got it, as far as I know, except me,
because I quit. I couldn't believe what I was hearing—this
garbage about picking professors to get a prize.
So I went to the library and got some of the classic books
on education, most of which were written at Harvard, and
brought them to the committee, and passed them around. I asked
them, "Shouldn't we be looking at something like this? I mean,
rewarding the teacher for being a good teacher is rewarding
natural talent, and everybody who isn't that good isn't going
to even bother anymore. That's the message that you're sending
out — skip it. Why can't we look at what teaching's all about
and try to facilitate better educational processes?"
When I handed out these books, everybody put them down like
they were contaminated. They were back to me in thirty
seconds. So I got a stomach full and walked away from that
committee shortly thereafter. And then, one or two of the five
prize-winner teachers that we picked were fired anyway.
Crawford: What were the firings for?
Blum: They had come to the end of their promotion time without a
suitable production of research and publications. You've got
so many years to make it. But that was a pretentious teaching
committee-- just an abysmal fraud, at best.
At the same time, I had a very similar experience in the
Academic Senate Course Committee. They asked me to review some
courses. There was a course about health that was being taught
elsewhere than in the School of Public Health, and it looked
274
pretty good to me, so I reported back to the next meeting that
I was happy to approve this course. Then I approved another
one, and somebody realized that I was kind of simple. They
said, "But maybe the School of Public Health doesn't want
somebody else to teach these health courses." Then I caught
on—this was a turf protection society.
Crawford: Against the threat of--?
Blum: Of some other department taking over, doing something useful in
your field. So they had to remind me, "Is it okay from the
School of Public Health standpoint?" I said, "It's a good
course." They didn't really care if it was a good course or a
bad course. This was a twenty- five member committee that had
to approve all courses to be offered on the campus at UC
Berkeley.
Blum: Another kind of academic committee work of probably more
significance goes on at the level of selecting faculty for
tenure. I played an interesting but shabby role on my first
plunge into that activity shortly after I received my own
tenure. I discovered something about why tenured faculty might
not always be particularly outstanding figures.
I was asked to represent the School of Public Health on the
final Academic Senate review committee for each of two School
of Public Health faculty being considered for the tenured
associate professorship. Quite by chance one committee met in
the morning and the second in the afternoon of the same day. I
boned up on each professor's background and publications so
that I could participate intelligently.
Unfortunately, as we met for the first evaluation in the
morning, there was no announcement of who or what nor was there
any paperwork to say which faculty was being considered. The
chair began by asking me to lead off, since I was from the same
school, to describe the candidate's capabilities and output.
Being a relative newcomer to the university, I didn't know
anything about the fields of the other committee members and so
remained clueless about which professor I was to discuss. I
was too embarrassed to admit my predicament and set out to
describe our committee's target, but which one was it?
I decided to meld and generalize the two totally disparate
characters from different fields, one in his late thirties, one
in his late forties. I carried it off quite successfully and
concluded by saying that this professor had a vigorous,
275
youthful approach to his work. A committee member immediately
wanted to know how come I said youthful, this candidate wasn't
young at all. I promptly caught on and made a quick recovery
by saying that he was a new father this very week, which was
true. Everyone laughed and we went on from there quite
happily.
Unfortunately, based on that experience, I have never been
able to feel secure about the quality of faculty consideration
about appointments for tenure.
I saw an interesting kind of discrimination in committee
work too, based on a "this is how we do it" unconcern. About
twenty years ago I was on a search committee for two tenured
faculty positions in the School of Social Work, serving as the
outside member. There were two male tenured and two female
non-tenure-track professors from social welfare on the
committee as the basic decision-making group. Each search
position had distinctive needs and finally we narrowed down the
field of candidates to one woman and one man for each slot. In
each case the candidates were well matched and either would
have been a good acquisition.
By the last scheduled meeting of the committee, it was
clear that we would get a good person whichever way we decided
for each position. It was also clear to me that the male was
the only one in each case who would be put forward to the
chancellor.
As we opened the last meeting, I couldn't resist asking how
many tenured women faculty there were in the school. The
immediate answer was, "None." With no further discussion, the
two women were selected and shortly became faculty. Even with
capable non-tenured faculty women on the committee, custom had
almost carried the day in a field more famed for its women than
its men leaders and practitioners.
Thoughts about Teaching and W.C. Fields
Blum: You asked me about teaching. Although I was almost always
treated as an interesting speaker and teacher, it is not clear
that I was really a good teacher, whatever that is. Certainly,
recorded renditions of various of my talks or lectures leave a
lot to be desired: repetition, slang, bad grammar, incomplete
thoughts keep them from being very impressive, and this
recorded history is no exception.
276
Be that as it may, students do tell me that they enjoyed my
courses, at times when there is no reason for them to say such
things other than good feelings—an issue to which I shall
return.
The most startling of such events of praise occurred one
day when I was just entering the elevator in Warren Hall for my
fifth-floor perch. A young man in his thirties happened
aboard, and immediately said, "You were a good teacher; I
really enjoyed your courses. You always reminded me of
someone." I thanked him and as he got off at the third floor
he turned back with some enthusiasm and blurted out, "I know,
W.C. Fields." And he was gone down the hall. I didn't really
have time to acknowledge this compliment, later came home and
told my wife, who wasn't sure about its implications either.
Neither of us had ever seen a full-length W.C. Fields
production and had our doubts, even though the comparison
seemed to have been made with the best of intentions.
Within the week we discovered that four W.C. Fields films
were being presented at a theater in Berkeley. We attended and
were pretty overwhelmed, not altogether unfavorably. I could
only assume that the kind of gross exaggeration that I as well
as W.C. Fields commonly indulged in had its values, both for
emphasis and amusement. We never did explore the negative
possibilities of my relationship to W.C. Fields. I can say
that I had my share of spirited students.
I think, however, that the many thanks I got from students
was in good part based on two quite different factors. One was
my willingness and even enthusiasm for going out on a limb on
issues of serious disagreement. Whether they liked my stance
or not, they knew where I stood.
Of more importance was being available for assisting with
problems, whether on course materials, concepts, university
pitfalls and rules, or on more personal matters, such as
health, family, jobs, whatever. I am sure that the dearth of
faculty who cared or would give time made someone who was
willing to help seem quite different and important as faculty.
Not unlike doctoring, teaching also involves caring about the
person who presents himself or herself for assistance.
277
American Public Health Association Involvements in the 1960s
Crawford: Before we move on to the seventies, would you talk about some
of your extra-curricular activities such as APHA?
Blum: I was once on the road in the 1960s to becoming an official of
APHA. When I was a health officer, I was on a whole series of
committees. One of them was chronic disease, which included
alcoholism, rehabilitation, and a few other things--! was
chairman of that for several years. Then I found myself on the
governing council of APHA, which makes the policies. It's a
big body which meets once or twice a year—I've forgotten
which.
I was also on the Technical Development Board. These roles
aren't on my CV--these are things done in passing. The TDB was
made up of about eighteen people—half came from California,
which I found interesting. This was the leadership group where
the guts of new decisions and policies were made by APHA. We
would meet a couple of times a year.
I finally discovered why there were mostly Californians
there—California was the only place where government would pay
expenses for health officers to go to such meetings. [laughs]
There was a different tradition out here. As I told you, I
could get my health department to pay. They would send me to
New York, or wherever the meeting was, and that was fine. And
APHA was simply too poor to buy our tickets and cover our
expenses, and we as individuals in public health weren't well
enough paid to travel to meetings on our own.
I'll never forget my last meeting at the Technical
Development Board, which as I said is on the way to the top
leadership, potentially, if you stay with it. Well, I never
really liked to be president of anything in the first place.
It always bothered me to waste my time being president, because
it involves a lot of ceremonial activities which I can't take,
or do well.
We had this tremendous meeting, chaired by the president of
APHA. The chief staff person was there, and all nine
Californians. The president's a Calif ornian- -we could just as
well have the meeting in Berkeley, it would have been cheaper.
We are debating two big measures about which we're going to
testify to Congress. TDB is advising the APHA president on
what to say.
278
The first measure was about whether the U.S. Children's
Bureau should be included in the U.S. Public Health Service
together with the rest of the public health programs. We
developed formidable logic about keeping it separate. It was
an interesting, effective bureau, and trained a lot of good
people and did a lot of good things. There also were many
people in the room who had loyalties to the Children's Bureau.
So this was a partisan measure. Many members of the TDB
didn't want the Bureau lost by putting it in the Public Health
Service, feeling that it would be diluted out, and MCH budgets
might be screwed around with- -they wanted to leave it as a
separate agency reporting to God, you see. So we developed a
logic of separateness, and I went along with it.
Then the next item we had to decide on was whether the
Environmental Health Services should stand alone or be made a
part of the USPHS. This time, we all agreed that they should
be included in the Public Health Service. We developed all the
exact opposite arguments as to why the Environmental Services
should be included--a counterlogic, almost word for word, to
everything we had said for the Children's Bureau. So in one
case we're going to appeal to keep them separate, and in the
other case, we're going to fight to include them. I couldn't
believe my ears.
I said, "Hey, fellows. Supposing you talk to legislators?
That's what you're going to Washington to do. And some of the
same ones are sitting on both committees. You give them all
the arguments for putting health services together, on one
hand, and you give them all the arguments for keeping the
pieces apart on the other? If they've got all their marbles,
aren't they going to get a little restive?" This thought
didn't bother anyone.
And this is the top level of APHA. So I started thinking,
Oh, the hell with it. I'm not going to stay with this, and I'm
not going to waste my time fighting it. I know what's behind
it, and it's probably not going to make any dif ference--this is
playing both sides of the street, and principle be damned. Of
course, they lost on both of them. [laughter]
At the next governing body meeting, again a similar display
of policy concerns and logics. It's full of "yes for this, but
no for this." The same grounds are being perverted, just using
reverse arguments, in item after item. This passes for policy
making and governance. Well, I'm not a perfectionist, but I'm
too much of a perfectionist to put up with having irrational
decision making every inch of the way. So I resigned from the
279
TDB, and I resigned from the governing board—and I never said
a word about making policy. I just figured the hell with it.
Crawford: They didn't want to know why?
Blum: Nobody cared that much. Nobody was going to miss me, really.
Nobody's ever missed, you know. At that point, an aunt of mine
died, and she was a person I really loved to visit. She lived
in New York; APHA was in New York then. I thought, Ah, I
really have no good reason for going to New York anymore. So I
stopped going to New York and the APHA, and that was that.
II
Blum: Getting back to being president of things--! became president
of the Health and Welfare Council of Contra Costa when I was
the county health officer, even though I objected, and I
objected. That was the first time I'd ever been talked into
being president of any thing- -maybe once before, I had—the
president of the American Medical Student's Association at
UCSF, but there was a purpose to that. Nobody else would take
it in their right mind [laughter], and yet the job had to be
filled.
But I said to these people, "Look, sooner or later you're
going to come before the board of supervisors, for whom I work,
and you're going to have an issue, and you're going to ask me
as president to present it to the board. The board is going to
say, 'Who the hell are you working for? Us? Or this other
outfit?' And they're not going to like it. It's already a
gross conflict of interest on my part, as far as the board's
concerned, when they see me show up to fight for something that
they regard as none of my business as their health officer.
It's the wrong place for me to be, and even more so if it is a
concern of the health department's. If I want to make a case
before the board of supervisors for something, I ' 11 do so, but
as the health officer.
Well, I finally accepted, and very shortly thereafter we
had some big deal, and I had to go before the board- -well, it
was preposterous. So we had to send the vice president,
[laughter]
So no more do I ever make that mistake. I'm not president
of anything. I may be chairman of a committee or something. I
ran into the same problem when I was chairman of the board at
Alta Bates, and chairman of the board at HEALS at the same
time — and the two came to blows. So I resigned at Alta Bates.
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Crawford: Your point being that you really could be more influential in a
different position?
Blum: Yes. Being chairman sounds good, but I've learned my lessons a
few times, knowing full well what was going to happen.
However, there are times when there are no choices. When I
wanted to run a health department I had to be the health
officer, and when we wanted to put the Joint Medical Program
medical school at UCB into shape, I had to be the chair.
Consultancies are fun, but being the CEO is where the action
is.
Advising Governor Reagan—Greed is Great; 1967 ti
Blum: I also worked for Reagan for a very brief time. Newly elected
Governor Reagan selected a diverse committee of about twenty
persons, to be chaired by his chief of staff, a successful
businessman, to tackle the problem of how to reform government
agencies to get more useful work out of them. I was one of two
UC Berkeley professors selected; the other was the eminent
political scientist and public policy expert Aaron Wildavsky.
We never saw the governor in the two meetings I attended
before 1 was dropped, but we got the full Reagan flavor- -why
are government workers so lazy, incompetent, interested only in
enlarging the scope of their duties, ensuring the security of
their own future and caring not a whit that their efforts at
enlarging the role of government was interfering with the
profits of the timberers, developers, industrialists, farmers
who might harm a few workers by using pesticides and herbicides
as they harvested California's green gold. This was the first
time I began to understand Mr. Reagan's credo, that Greed is
Great and that greed makes America great. All this could not
be blamed on incipient Alzheimer's, for this man had come from
the far left in college on to the presidency of the supposedly
left-leaning actor's union. But there he became the stool
pigeon for the FBI, putting the finger on liberal movie
industry people.
This was an interesting situation for two Berkeley
academics who were obviously also government employees,
probably of the most unproductive kind, and in my case actively
concerned with planning for health, which could only result in
some kind of restraints on the earnings of the health and other
sectors, not a minuscule part of our thriving economy but one
281
of its major growth areas, and would lead to restraints on
other sectors that adversely affected health.
I was not at liberty to point out that Mr. Reagan's
diagnosis of the faults he found in the public sector were
exactly what one would expect from greedy Americans who would
end up in secure positions and make their greedy mark by making
themselves more important and by creating an even bigger
machine of government control, and with more influence for the
great profit-makers.
Since my experience with government workers in the health
and education sectors had introduced me to thousands of persons
who in fact were satisfied with poor pay and rather looked
forward to improving the safety, education, and health of the
people of our country, I felt that Mr. Reagan was becoming a
pretty atavistic character and would soon be a destructive
force against health, education, and conservation wherever he
could.
In fact, the kinds of people Mr. Reagan brought into the
state government as he set up new and more powerful entities to
interfere with the operating departments greatly increased the
size and cost of state government while its effectivity was
lessened by slash-and-burn personnel policies, cutting up and
moving parts of departments like the state health department,
one of the best in the country, into sites as far apart as
Sacramento and Berkeley, getting incompetent top-line
bureaucrats who would hold up any kind of health- improving
measures that the governor couldn't kill legislatively. Yet
the times were such that more not less health services and
education were demanded and authorized, and it took even more
expansive bureaucracies to hold up and derail new programs.
Mr. Reagan's efforts to promote profits over everything else
were actually attended by skyrocketing state costs, obviously
good practice for what he did as president.
The only advice I could give was that if Governor Reagan
would treat government employees as reasonably as normal
people, he might get them to cooperate in mitigating endless
bureaucracy, and perhaps see things in a more variegated light,
one that encouraged the values of production for profit, and
help the producers see that they too could gain from helping
with a bit of their profits to create a healthy and educated
society that could work harder and better. This went over like
a lead balloon- -government was the enemy and had to be
destroyed, and I was never invited back.
282
Wildavsky was strangely and atypically silent. He was a
brilliant thinker, an enchanting speaker, a Catskillian summer
theater type of entertainer. Once when he was asked to address
a national gathering on policy for health care he asked me for
a few key references. I gave him three, which made it all too
clear that health care, expensive as it is, is not what keeps
us well. He turned a hundred pages into a classic brief speech
that ended with the oft-quoted comment to the effect that his
mother's admonishment to use chicken soup and avoid the doctors
was good policy.
Wildavsky was opposed to any and all planning, saying that
planners were too ignorant to understand what the forces really
were that they were trying to harness. Unfortunately, a
realistic appraisal of much of planning. Thus, they might do
more damage than currently existed without planning and
therefore society was better off to be guided by greed, or the
market, as we like to describe it. He clearly was on Mr.
Reagan's side. I called his school of thought "I'm all right,
Jack," since he and people like him weren't hurting.
But it was a bit discouraging for him to be labeled as a
"hog-in-the-trough" state employee. He didn't last on the
committee either, as he tried to raise the level of the
discourse of Mr. Reagan's brain-trusters as they led the
committee to the great new horizons offered by unbridled greed,
and well-bridled government.
Planning for Health and Expanding Health Care Horizons, Two
Textbooks: 1974, 1976
[Interview 6: April 3, 1997] ft
Crawford: What about changes at the university after the 1970s?
Blum: In the late sixties, the campus was very politically alert, and
social justice was very, very important, but not in the School
of Public Health. We still had a lot of professionals coming
because it was "the" thing to do, and if you came to school and
put in another year and got a masters degree, then you might
get a salary increase somewhere or be eligible for a better
position. Really impressive.
Then, all of a sudden, that kind of person died out. Early
in the seventies, we started seeing a very different kind of
student, people who were interested in social justice and who
283
felt that health was a good place to work, and who were
concerned with the terrible inequalities in health, and
inequalities in all kinds of things that seemed to determine
how healthy people would be.
Previous to that, I don't think the faculty was really
challenged that much. They were the authorities, but people
who came to school in the seventies certainly didn't agree to
all of that—not by a long shot. So it became much more
interesting, much more exciting. There were all sorts of fun
people that we had to deal with, and I had some wonderful
experiences with students here.
Crawford: Dr. Winkelstein was dean for most of that decade?
Blum: He was dean most of that time, and he too was concerned with
such things as social justice, and was very open to any kind of
reasonable suggestions. Really, the life of a professor at
Berkeley was never hemmed in. You could do your thing, and
there were two issues: one, could you manage to get something
published so that it looked like you were on the ball; and,
two, could you attract students?
Crawford: Not unreasonable demands, you felt?
Blum: No, no. The publishing was relevant, if not carried to
extremes --assuming you had ideas, and they were worth airing.
The ability to attract good students was a very positive kind
of thing—not the sort of thing that the teaching committee was
interested in, unfortunately, as I mentioned before.
The other day when I went to a meeting in Sacramento, I ran
into people who had been students of mine thirty years ago and
who remembered what had happened and felt very good about it.
It wasn't, "Oh, here's this poor old guy, wandering around
Sacramento." There was some enthusiasm.
Crawford: I have found that to be true in your case. Wouldn't that be
true of professors who lent themselves to the students?
Blum: Well, I think that had a lot to do with it. Yes, were you
there to be sure that the students' interests were covered?
That might mean covering your own, and, presumably, there was a
convergence of interest. They wanted what you had to offer,
and you wanted to do what they were interested in, but it was
no struggle on the part of either party. So it was a good
time, and the students improved tremendously. You could hardly
complain.
284
I think that what's worth commenting on, though, about
those first few years is that as I look back on it—and I'm
really kind of startled—is my putting together that first
textbook in 1974 on the subject of planning for health on a new
basis, Planning for Health. It wasn't planning for care; it
was planning for health. Much of what I had to say there
couldn't have been new. I have long since learned that other
people have said these things going back for a couple thousand
years, but the basis of what I had to say, really, is just now
coming out at WHO, thirty years later.
There is a WHO document that just came over my desk last
week; it's about a meeting held at the end of 1995. It takes
them roughly a year, typically, to develop a document and
distribute it worldwide—this went worldwide. Almost all the
things I was concerned with and pushed for are finally here. I
Thirty years
feel very good about their getting on the ball,
later? That's not bad.
Crawford: What has been the usage of your planning book?
Blum: Very, very limited—two editions. It crops up in odd places.
A fellow came by here the other day who had never gone to
school here, but who works in Washington, D.C., and he had a
book in tow. He said, "Look what I found in the second-hand
bookstore. I want you to autograph it." [laughs] It was a
first edition of Planning for Health.
Crawford: How many editions?
Blum: Just two. [Second edition: Human Sciences Press, New York,
1980.]
Crawford: Is it still used as a textbook?
Blum: I seriously doubt it. It wasn't heartily received then,
because it ended up saying you just simply can't look at health
care as any answer to improving health. Health care is where
all the money goes, but it doesn't improve health in people
very much. The real issues are social and economic, and
cultural and educational; I called all that environmental.
I remember my big battle with the U.S. Public Health
Service. To this day, they claim that environment is 18
percent of the problem, and behavior is 50 or 60 percent.
Someone named McGinnis put all that together and gave a lecture
here. My students really took him apart. "How can you say
such nonsense? The environment is what determines how healthy
you're going to be." He said that by the environment he only
285
Crawford:
Blum:
Crawford:
Blum:
meant the air and the water and the soil and the accidents on
the job kind of stuff. Social and economic and educational and
cultural issues were not assigned to the PHS and thus not in
their definition of environment, and so he could freely say
that environment was not a big factor. This was and continues
to be the position of the USPHS, where he is an assistant
surgeon general.
So if you looked at it that way, and got rid of all the
major causes of good or bad health, then you could say that
behavior was the remaining, single, largest factor. These
would be purely behavior; smoking and drinking, dangerous
driving, and sex. All of this you could bounce back on the
individual, and most importantly, avoid asking for social
change .
The other bit of stupidity in taking that position is that
there is no such thing as behavior without an environment. The
environment dictates or creates behavior. How is it that all
the smoking, practically speaking, occurs in certain places and
certain groups? How come all the heavy drinking likewise? And
how come all the promiscuity? These are real problems, they
occur in certain socio-economic, cultural environments, and
those are not just god-given behavioral factors. They are
responses of human beings who seem to experience these
differences in environment. But changing behavior is the
garbage that is officially peddled in the United States. Yes,
it can and does work in some situations, but usually not among
the people who need to change the most.
We're not further along the road?
Not in the United States, but very much in most other
industrialized countries.
Were you instrumental in this new work, do you think?
certainly that was the thrust of your report.
Because
It is hard to know. I suppose so. A lot of people picked it
up. At the identical time that I was doing this work in the
1970s, the Canadians did the same thing—except it was
published by the Canadian government. It was called The La
Londe Report. I was working for PAHO occasionally at that
time, and in the PAHO office I met the man who wrote that
report for La Londe. His name was La Framboise. He had all
these wonderful charts and pictures, and they were the same
sort of things that I had.
286
Neither of us had ever heard of one another, and we're
sitting there in New York looking at one another, and it's just
astounding. They published hundreds of thousands of copies and
distributed them around the world; the La Londe Report had a
serious influence, yet was never taken seriously in the U.S.
because it smacked of social justice.
La Londe was a gifted and trusted man who was the head of
health and welfare for the Canadian government, under Trudeau.
And then, when he got through giving real credibility to the
health sector, La Londe was shifted over to law, where he also
did very fine work. He was, apparently, a powerful force. The
interesting thing is that almost all of the new Canadian era of
understanding the origins of health were inspired in French
Canada.
All of this was based on the work of another committee
headed by Castonguay and Nepveu. They took about five years to
develop the theory of health. They covered the philosophy of
every civilization, practically—and they came up with the
notion that health was really based on response to environment.
Crawford: Does this thinking come from France originally?
Blum: Not from France, but from French Canadians. And yet it was
once in France, too, a long, long way back—but with no
continuity.
The commission lasted for about five or six years, and
Castonguay, of all things, was an insurance man, brought from
the private sector, where he was one of these people who
measures risk—in any event, brilliant. The commission issued
a seven-volume study, which I once bought and finally gave to
the library. I'm sure it's been lost since, but the Castonguay
and Nepveu Report, which resulted in the La Londe kind of
thinking, was very much a product of these French-Canadians.
Crawford: What have your Canadian students found their way into?
Blum: Well, they're almost all in health work of one sort or another.
The Canadian government, particularly in several of the
provinces, did lots of wonderful things that I also thought
needed to be done. They put together health, welfare, and
mental health, and said, "This is people, this is human
service. It belongs together." They did that in many
provinces — and did a good job. They're way, way, way ahead of
us .
287
Crawford:
Blum:
Crawford;
Blum:
Crawford:
Blum:
We always hear people saying they will go to Canada when they
retire to get good health care.
Well, of course, that's real care--not just medical care. When
you say health care here, it always means medical care; not
there.
You worked on curriculum development,
into the seventies and eighties?
How did that develop
We became aware of the fact that what most people call policy
was just one more manifestation of planning. Or, at least — for
a planner, you could plan in many places and at many levels,
and the first area you would probably want to plan for would be
policy—what is it we want, and after that how are we going to
get it?
But then as you plan for this and you plan for that, you
finally come down to planning for services at the end of the
line, it's just a continuum. If you don't have any policy, I
challenge you to come up de novo with services that are
meaningful, because you don't know with what purposes you are
carrying them out.
You're not going to do the policy work successfully unless
you have some sense of what's involved in this field. So in
health, I had to start with health. I didn't see how you could
plan for health if you didn't know what health was or what
affected it. That was the first statement 1 made to myself.
Your focus was really policy?
Well, it was a mixture. I ended up calling myself a professor
of health policy and planning, because we got into policy in
fairly short order, thanks to some wonderful students. I told
you about how the planning course started, with each student
doing a piece. But the policy course per se involved a pre-med
student who got an M.P.H. here and who is now at the National
Institutes of Health, Pamela Gurnick. She just sat down with
me for the best part of a semester, and we hatched out the
policy planning course, but it was much her doing—a terribly
bright person.
We grew into policy, because it became clear you couldn't
not grow into policy- -you had to do it if anything was to take
place.
288
Crawford:
Blum:
In 1976, you published Expanding Health Care Horizons.
Party Associates, Oakland]
[Third
That book originated as an invitation to present up-to-date
thinking on what health was and what health care might best be.
Each of three authors was given a week in which to present
their views. Ivan Illich presented Medical Nemesis, Rick
Carlson did the End of Medicine, and I presented what health
care should be doing if it were based on our understanding of
what caused good and bad health, something a lot different than
the repair concept of Western medicine.
Roz Lindheim, an architect whose work in health opened many
new avenues in health care, appears in several contexts in this
book because she influenced many of us in many ways, got me
invited to Cuernavaca to CIDOC, Centre Intercultural de
Documentation, which was Ivan Illich1 s own institute and which
enjoyed the protection of the liberal archbishop of Cuernevaca.
Illich was a priest who came from Yugoslavia, was trained at
the Vatican and was reputed to be a protege of Pope John.
He had written many controversial books, all of which
sounded a strong anti-organization theme, probably built out of
his experience and objections to bureaucratic, authoritarian
organizations like the Catholic Church. As the one-time rector
of the Catholic University of Puerto Rico, he had strong
feelings about the limitations of traditional universities and
CIDOC was his own creation.
The institute earned its way by teaching Spanish to well-
off persons needing a rapid and reasonably thorough Spanish
grounding. But its overriding purpose was to piggy-back high-
level discussions of all major social issues, as well as
maintain an elegant library and a place for him to think and
work. His medieval-style university CIDOC was an unlikely
mixture of the ultra-technical reception machinery, and a
freedom to wander, imbibe, and disperse information and ideas
in an almost market-like intellectual setting.
When one arrived, one was set down in front of a suitcase-
sized mechanized monster which took your fifty dollars, took
your picture and a small ticket you had filled out, and turned
out a wallet-sized plastic-encased I.D. card that allowed you
to attend for the rest of the year. That allowed the card
holder to attend any and all presentations, of which there were
a dozen or more going on at any one moment.
289
It might be medicine one month, a four-hour-a-day series,
with half presentation, half discussion, history of the
Philippines which we attended, or philosophy, whatever.
Illich toured each series at least once a week and gave a
resume of all the courses that were being presented, truly an
unbelievable tour de force. We had attendees in ours from
twenty-three countries, and since presenters were paid
according to the number of attendees (out of their $50.00
fees), we were paid more money than it cost us to travel and to
stay there for a week.
To prepare myself, I put all my ideas into paradigms,
chains of logic, summaries, and presented about a hundred
charts and tables in my week. Given its success with an
international audience, I did what any respectable professor
would do: turned it all into a book, Expanding Health Care
Horizons, a title suggested by a confrere who then denied
vigorously that he had ever named anything, even though he
approved of the book. I obtained a contract from Warner, and
Harry Specht, the dean of the School of Social Work at UC
Berkeley, was the editor for them.
Harry had worked under me as the CEO of the Contra Costa
Health and Welfare Council for the one year I was its
president, and we enjoyed one another. He went on a sabbatical
to Europe, injured his back, and lay on the floor of their
leased van for months while his wife drove, and that was where
he edited my book. He did a magnificent job sharpening and
clarifying, never once ruining what I was getting at.
After all that, Warner was sold, perhaps it became Time-
Warner, it cancelled its contracts, and here 1 was. I wanted
the book for my classes. Because it laid out the new look for
health care that I wanted to use, a pair of former students,
Helen and Paul Mico, who created a publishing house at that
moment, Third Party Publishing, took it as their first venture.
Since they had so few books, they had no budget for
advertising, so it remained mostly for local consumption. It
brought all my major themes together and from time to time I
get asked to sit in on the founding of a health care venture
based on the premises held forth in that book.
We had a lot of dealings with Illich while we were there,
partly fascinated, partly repulsed by this formidably talented,
educated, and experienced empiricist. Fascinated by the
searching questions he asked, repulsed by the elitist answers
he typically gave.
290
Wasn't organized education creating a great subclass of
those who never could get any of it, therefore shouldn't we do
away with organized schooling? Similarly for medicine, and so
on. My preface to Expanding Health Care Horizons responds to
that philosophy rather vigorously.
Anyhow, we thought he would be good for Berkeley, got him a
Chancellor's professorship, and he spent a semester in
presenting a formal course on gender [1982-1983] and holding
parallel seminars and soirees on various related issues. I did
all the necessary paperwork and petitioning. Roz was in
Europe, and I sat back to enjoy what could only become an
intellectual fracas.
His class drew 500-700 people for every single lecture.
The large home he rented with his stipend was busy at all hours
with truly intellectual forays. This was old-time intellectual
fare of the highest order. Several UCB women faculty were
truly indignant over what this maybe celibate priest had to say
about gender issues, and proceeded to write heated responses in
book form.
He has been at Heidelburg the last few years and is, by my
standards, becoming more respectable or less controversial.
The Hospital World: Alta Bates and Herrick Hospitals and HEALS
Blum: At the same time during the seventies, I got pulled into the
hospital world, which I also loved, even though it was a long
way from policy planning at the community level. I was asked
to help with the planning at Alta Bates Hospital, and that's
because of former students who were now running Alta Bates.
Crawford: Let's talk about that.
Blum: In the seventies, I was planning with Alta Bates, and they and
Herrick were in sort of a death-throes battle for survival.
One of my co-professors, Dave Starkweather, was the key
force on the board at Herrick. He didn't want to be the
chairperson there, because he was wise about that, but he was
certainly the brain there. I got to be pretty much head of the
planning at Alta Bates, although they had several full-time
planners on the staff. They were well-paid people.
291
He and I came to a pretty rapid understanding that no way
could the two hospitals survive in Berkeley. This was in the
early seventies. It was just ridiculous. They were going to
have to join together. In 1981 I went onto the board at Alta
Bates, and ultimately became chairman of the board for a brief
period- -it was my last year there, at which time the two
hospitals were, literally, joined, and made into one, which is
now called Alta Bates. We finally engineered it, and it took a
long time, until 1984. First, we went through the trustees,
who were not physicians. The physicians hated one another.
The administrators hated one another.
Crawford: Is that surprising?
Blum: Well, no, you want the business, they want the business, and
there's not enough business—that ' s the real issue. Remember,
at this point, there were new hospitals coming into service in
Alameda County, Contra Costa County, and so on. In the case of
Contra Costa, patients that used to come to Berkeley went to
John Muir, and maybe to Concord, to Mt. Diablo, and maybe to
Brookside in San Pablo, and then to Doctor's Hospital in
Pinole. At that time Kaiser was also making huge inroads into
patient care.
Crawford: Is Kaiser not a good program?
Blum: No, that's not the issue. It was making horrible inroads ,
taking customers.
Crawford: Enormous inroads, but not negative ones?
Blum: I don't think so. People got at least as much as they had ever
gotten—for a lot less.
Crawford: Was this the era of the MBAs, when they came in to administer
in hospitals?
Blum: Yes, and, in fact, Starkweather was specialized in hospital
administration, and I was not. I was interested in health care
in a broad sense, but I played the narrow hospital game, too.
That's how you learn what's going on, if you're in it.
Under his auspices and doing the work, but under my
chairmanship, we set up the joint masters degree between the
School of Business and the School of Public Health. With a
three-year program, a student could get two masters degrees, as
I've said, and they were typically headed into the Kaisers, the
Blue Crosses, and the Blue Shields of the medical world. We
trained a lot of students that way—we're still doing it.
292
Dave Starkweather and I were very, very different people,
and we were interested in very different things. He was very
much a computer nut, and I could care less--I haven't seen any
good thinking coming out of a computer. I was interested in
which way to go on issues, and he was interested in getting
there. So it was a good match-up. All my students tended to
take his courses, and his students tended to take my courses,
but then they pulled apart when it came to a career. They were
very, very different people, obviously. But it was good for
the two of us, each in his own department and each in his own
hospital, and able to exchange. We had adjacent offices, you
see, in Warren Hall.
So we got these two hospitals together. One of the big
battles we had lived through was over emergency services.
There was a statewide program, which has since somewhat fallen
to pieces, of having emergency services — good ones. There was
the issue of whether it would it be Alta Bates or Herrick that
would be the chief emergency servicer in the Berkeley area, and
remember, emergency generates business. People come in who
have no intention of coming in, but they're there, and when
they need hospitalization, you've got them. Often, it's around
accidents, and in those, there's usually money—there' s some
insurance or something, you see. Many people can pay. Well-
to-do people also get into accidents.
Anyhow, Herrick was much more dependent on its emergency
room than Alta Bates. Alta Bates was slowly pushing its way
in, and they just about displaced Herrick. So here we were,
with great big meetings going on about how we ought to work
together and not kill one another, yet there was only room for
one such service in the area. This is what's known as
competition in the hospital business, and it means that prices
go up and up and up for everybody, because everybody is trying
to do everything without adequate volume.
So we had this meeting, and I was still chairman of the
Alta Bates planning group, but not on the board at Alta Bates
yet; it was early in the eighties. We listened to all the
competing claims, and it was crystal clear to me that Alta
Bates was chiseling its way into Herrick1 s territory. I had
been appointed as one of the people on the committee, and there
was the chairman of the Alta Bates board as chair of the
meeting, a man by the name of Manlove, a very interesting,
powerful force on the Alta Bates board.
I listened for an hour or so, and I said, "Well, Mr.
Chairman, as a member of this committee, I move that we agree
to give the emergency services to Herrick. That's where it
293
started, that's where we all agreed it was to go,
that we honor that agreement."
and I suggest
So it was moved, seconded, and passed with only one or two
negative votes. It was just so obvious, it had to be that way.
When I came home, it was on a Friday evening. I said to my
wife, "We're going to get a phone call shortly, and we're going
to hear from the chairman of the board of Alta Bates, and I'm
going to be disengaged from any further work for Alta Bates,"
because I had really, really kicked in that whole profitable
business, thoroughly and intentionally. I don't believe in
stealing, even between public institutions. [laughter]
Sure enough, we're sitting down to dinner, and the phone
rings, and she says, "A man by the name of Manlove." I said,
"Hi, Bob, what can I do for you?" He said, "We need you on the
board of trustees at Alta Bates." [laughter] I said, "Really,
I hadn't come to that conclusion, myself." Then I said, "Sure.
I'd love to." Given the occasion, it was a good augury.
So that's how I got on the board at Alta Bates. It was
just the exact opposite reaction of what I expected.
Crawford: They recognized a strong man.
Blum: It wasn't just that. Their move was foolishness. How much
chiseling can you do, in the long run, with everyone watching?
So I stayed on the board, and we had a wonderful era of
planning. The administrator there, who was very antagonistic
to Herrick at the time, was a very, very bright guy. He is a
real big shot around here now, and somebody that I always
enjoyed working with- -Bob Montgomery. A good planning group
was just critical to everything he undertook.
Just about that time things for Alta Bates really settled
in and became hard--I mean, we had gotten the Medi-Cal decision
that it was only going to pay so much. I'll never forget the
trouble we had getting the board to understand that if our
average cost per day is $900, and Medi-Cal only pays $600, that
we're really not losing $300 a day if taking in that new
patient into an otherwise empty bed only costs us $400 a day to
take care of. Never mind the average cost; the truth of the
matter is that if this Medi-Cal patient costs us $400 and
they're giving us $600, we just got through making $200. That
sort of thing was particularly enjoyable, because I got to know
a lot more about what I was teaching, in contrast to many
teachers who had little contact with actual operations.
294
Crawford: The real thing.
Blum: Yes, in contrast to most people who teach and do exhaustive
research on some arcane issue. They read about it in the
literature, and this particular set of discoveries showed up at
least five or six years later in the literature. Well, here
you're living it right now--I'm representing a hospital and
going to Sacramento, and arguing about the rates, and trying to
get a little more money for Alta Bates from the state.
Crawford: From Medi-Cal?
Blum: Yes, and it was feasible, and we did get some more. And, at
the same time, hassling with Herrick and saying, "Come on, come
on. If we get together, we can all survive." Sure enough, the
docs were finally amalgamated, and the cardiac group that was
Herrick and the cardiac group at Alta Bates have gotten along
famously ever since as one group. They are all part of a
bigger medical group.
Crawford: Which is what?
Blum: Well, it was just a group of heart people that now relate to
Alta Bates, but they used to relate to two hospitals. Now it's
a big operation. They couldn't have survived divided. Alta
Bates had trouble, even after they amalgamated, to really get
through some of those bad years. The doctors and the hospitals
slowly learned to work together as both were in danger
otherwise .
As soon as we amalgamated the two hospitals, we turned to
Blue Cross and said, "We want more money for hospitalizing your
cases . "
Crawford:
Blum:
We suddenly had the control of the local market. There was
no more Herrick to compete with; there's no immediate
competition. We could work more cheaply together, but at the
same time, we didn't have competition. So we could tell Blue
Cross, "We want more money. Otherwise, you have got to make
your Berkeley subscribers go to Pill Hill"--well, they may not
want to go to Pill Hill.
What's Pill Hill?
The amalgam, there, of Merritt and Peralta and Providence--
that's Pill Hill. That's just five or ten miles away, but
Berkeley-oriented people don't want to do it. They'll buy some
other insurance if they want to stay here. Most people don't
enjoy changing their source of medical care.
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Crawford: You had a good bargaining wedge.
Blum: All the stuff that isn't supposed to be, you learn. We had
meetings at seven in the morning practically every day, and,
then, at noon many a day; and then in the evenings—either
during dinner or after dinner.
Crawford: All the while working full-time here.
Blum: Yes, it was really a wonderful time, and, at one point in the
seventies, Bob Montgomery and I and a few other people had
decided we should have our own HMO. If Kaiser got all the
business, they'd send their subscribers not to us but to
Kaiser's facilities. So we created HEALS, an HMO, in 1978.
Before it was all over, I was chairman of that board for some
years, from 1984 to 1987. My last year on the hospital board
was the year the merger really sank in, about 1984. Chairman
of the Board of Trustees-- ' 84. So it was that late. It took
all those years and years and years of struggling.
II
Blum: But to get to HEALS: several physicians at Herrick wanted to do
something, felt we just had to stop Kaiser's inroads, and the
administration at Alta Bates felt the same way. This is
interesting—it wasn't the docs at Alta Bates, and it wasn't
the administration at Herrick. Between us we finally convinced
each of the organizations to put up some money, and we would
partner equally in setting up HEALS. The name was suggested by
a doctor from Herrick. It was a good name. HE and ALS
represented key letters from Herrick and Alta Bates.
Crawford: Appropriate acronym.
Blum: It sounded good. But anyway, nobody put up real money. Alta
Bates put up something like twenty thousand; and then Herrick
put up twenty thousand. It is ludicrous. You needed about a
million and a half, or two million dollars, to get started, and
today about twenty times that.
Crawford: What were the ramifications of setting up an HMO?
Blum: Well, in the first place, you had to have a marketing arm;
somebody had to sell a service policy to industry or to
government and other big employers who are the purchasers. It
was very clear that we could sell it to the two hospitals for
their employees. If they founded it, they would provide it for
their own employees, but even they were reluctant to do this,
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Crawford:
Blum:
Crawford;
Blum:
as HEALS paid them less per patient-hospital day than most
other HMOs and insurers.
So we had some customers, but supposing you wanted to come
to the university to sell HEALS insurance. They're the biggest
employer around. Well, then one suddenly needs PR; you need a
whole publicity machine, and you've got to set up the business
and operations side, so that when you hand out materials,
you're able to say how you work, what your relationships are,
how referrals take place, what doctors are used. Before that
you've got to sign up doctors, and you've got to sign up
hospitals and set up the machinery to take in the purchasers'
money, direct patients, pay doctors, on and on.
More or less the same staff doctors you had?
Well, remember that the so-called staff doctors didn't work for
the hospital. They were all in private practice, and many of
them worked in two or three hospitals. So you had to get them
to agree to take HEALS subscribers as patients. You had to get
the hospitals to do so also, and at our prices.
So first you had to develop the prices; the whole bit, and
then how much money for drugs? How much could you expect? How
much could you afford to pay? How about the business side of
dealing with doctors and sending them their money, and dealing
with the hospitals and sending them their money, and dealing
with patients and their problems, and selling memberships? It
was a tremendous ground-up effort, and essentially done with
almost no money.
Was Kaiser an HMO in the strictest sense?
Always. Yes, it always was, and not for profit,
out not for profit, too.
We started
We ended up hiring a brilliant administrator named Dennis
McKenna from Kaiser somewhere down in the Los Angeles area. He
was a young hustler, and we practically lived with him. There
were four or five of us--me, Montgomery, Manlove, Jerry
Kaufman, McKenna- -hatching the program at all these stages, and
then reaching out and finding somebody to do the selling,
reaching out and grabbing somebody to do the PR, then getting
business types, section by section, for drugs, medical care,
hospital care; pulling people in to help work out the
negotiations with the hospitals.
We had to negotiate with all the hospitals around, and we
finally offered our plan in San Francisco, San Mateo, Santa
297
Clara, Yolo, Solano, as well as Alameda/Contra Costa counties.
And then we had to get the medical societies not to obstruct.
They hated HMOs, because HMOs had meant more Kaiser for some of
them. Most welcomed HEALS which used only private
practitioners .
Crawford: And it meant ceilings, didn't it, on private practice prices?
Blum: Well, it ultimately would—at least it would interfere with how
they charged, right off the bat. The doctors in HEALS were not
paid on an annual basis, neither per patient nor by salary.
They earned the money on a fee-for-service basis, and we had to
negotiate how much they would be paid for every single
procedure. We had to negotiate: how much for a tonsillectomy ,
an examination of a tonsil, an examination of an eye, a
cataract—what does it cost to remove. Well, you'd borrow such
information from here and you'd borrow from there, and you'd
add it all up, and how many of these will there be per patient,
and how much on average for each subscriber? Because that's
how much you have to charge the purchaser for each employee
they would insure with us.
We had some guidelines. One was that we weren't going to
be much more expensive than Kaiser; we were going to stay
within, maybe, 10 percent of Kaiser's monthly costs.
Crawford: Was this easy to do?
Blum: No. You're starting up, and you have no money; there is no
reservoir of bucks.
Crawford: All you have is your physical plant, basically, isn't it?
Blum: You don't even have a plant. You just rent an office. You pay
for each service given to each subscriber. If they are taken
care of in Pill Hill, or here, or there, or elsewhere—there
are pre-negotiated rates at which hospitals are going to take
care of them. All that has to be negotiated. Everybody's
giving you a rough time. Everybody's surviving.
Dennis was a bit of a genius. We were told at that time
and everybody knew that a plan had to be nationwide. Dennis
really felt quite differently, and persuaded me, that you had
to be regionwide, but that it wouldn't be enough just to be in
a county, that we had to be regionwide because, for example,
Standard Oil has a plant in Richmond, but its workers go home
at night to five or six counties. So you've got to be in those
six places. Region was the issue.
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Crawford:
Blum:
Crawford:
Blum:
The San Francisco Bay Area was a good, sizeable region; the
people who started out and tried to go national—most of them
went crazy. Ultimately, HMOs kind of got back to it.
The doctors didn't trust us; they didn't really look
forward to an HMO, but many of them did put in twenty- five
hundred dollars, which would be theirs. They could have taken
it back out; they got stock, ultimately, for it.
Originally, it was a not-for-profit plan and there was no
stock. What we did was withhold on every doctor: he'd done
various services, and billed for them, and got paid for them,
but he wouldn't get all of his money—he'd get 80 percent — and
the remainder would be held in a pot until we had some cash to
turn around with.
When you start out with just a few hundred doctors and four
or five hospitals, you don't have much volume. That withhold
is critical; otherwise you can't pay your bills. We were
always staggering from one hour to the next, paying our bills.
If a baby was born prematurely, we practically had a board
meeting over it, because this might cost you thousands of
dollars a day— at Children's Hospital in the East Bay, it would
cost you the best part of two thousand dollars a day.
In this case the baby may stay in the hospital for a month,
two months, three months. We didn't have that kind of money,
so it was one long hassle. Yes, we could have gotten better
prices in San Francisco at UCSF, but did you dare ask a parent
to move their premature infant to San Francisco?
All these things were quite revealing. We went through a
thousand things, so we were always negotiating with everybody
over everything. Originally, because we didn't have too many
customers, the hospitals wouldn't give us a good price, nor
would the pharmacists, labs, and x-ray people.
What was HEALS1 range?
Well, we started out in Alameda/Contra Costa, and then moved to
the whole Bay Area.
Did you benefit from Kaiser's expertise in this area?
Well, in the sense that the person we hired to head it up was
savvy to the Kaiser business operations.
Crawford: Were they resistant to what you were trying to do?
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Blum: No, it was just a matter of business — they 're going their way,
you're going yours. Kaiser is so big that it's hard to say
that they were resistant to anything, or cared. Half the docs
here were ex-Kaiser docs — in this area that's how you proved
that you were a good doctor; you left Kaiser. It's kind of
interesting; it really tells you that Kaiser must have been
pretty good in the first place.
So our own doctors did us no favors, and they still went on
overdoing, overdoing, over-prescribing. Instead of generic
drugs, they'd go for trade names. The difference in price
might be five-fold.
We had committees of physicians, and the place was run by
doctors, really, because in the long run, they write the
prescriptions, they send the hospital the patient. But it
turns out that it's very hard for a doctor-run organization to
stick by their guns. In other words, if they see a doctor
who's wasting procedures or doing unnecessary surgery, it's
very hard to step over and say, "John, my old friend, you're
going to have to knock it off. You can't be doing that." And
they didn't succeed at controlling needless services. We'd
always, year after year, lose a half a million bucks, one way
or another. But that's chicken feed because our revenues were
a hundred million almost overnight. The HMO grew fast.
Crawford: Who absorbs the loss?
Blum: You don't. It just stays on the books. Or that 20 percent the
doctors are supposed to get back? Well, they don't get
anything back, and that 20 percent is used to make the
organization solvent. It teaches the doctors just the wrong
thing, that they had better grab their money and run, because
they're only going to get 80 percent of what they think they're
going to get. So there are many kinds of incentives in the
picture. The withhold worked just the opposite to what it was
supposed to do, that is, encourage thriftiness so you could get
it back.
I remember just a year or two ago I went to see a man whose
father had been a doctor in my day at HEALS, and he said, "I
remember your name. You were involved in HEALS?" I said,
"Yes, I sure was." He said, "The doctors really kind of ruined
that, didn't they?"
Well, that's exactly true, by not watching out for
avoidable costs. Instead of HEALS becoming more and more
valuable, it was really starting to build up debt. So it was
sold to QualMed. QualMed became HealthNet, and now HealthNet
300
and somebody else are going together,
monsters, now.
It's one of the
The doctors were in a position to make it or break it, and
they were very casual about breaking it. They didn't see it
was in their own interest to make it successful. They would
never get it into their heads that HEALS was detouring patients
to them who would otherwise have gone to somebody else. For
instance, the first year HEALS was offered here at UC Berkeley,
we outsold Kaiser. That's unbelievable. And all those persons
who shifted to us from Kaiser meant new patients for our
doctors .
Crawford: That is unbelievable. Was that the force of your marketing or
discontent with Kaiser?
Blum: Well, both. In the first round, you will get the discontented
people. Secondly, our price was very close to Kaiser's, so
that the university agreed to pay for it. The patients then
have the chance to get their own doctor and go to Alta Bates
and not to Kaiser and not to Kaiser Hospitals — and the price to
them was identically zero. In fact, the university absorbed
the difference. You didn't have to pay anything for this.
Crawford: How did you get the university to go with HEALS?
Blum: It was a bargain. But it took a little talking, I will say.
Crawford: Did you lobby for it?
Blum: Not really, because as a faculty person, that wouldn't look too
good. Dennis McKenna, our chief operator—our guru—did it
with assistance from other people, but it was obviously the
thing to do. So HEALS was really a wild success here.
Crawford: How long was your involvement with it?
Blum: Quite a long time. In the course of a few years, I became
chairman of the board, and I was chairman for quite a few
years. I was chairman from "84 to "87, as I said, and it had
taken almost a decade to set it up.
Crawford: People complain because the hospital stays are so short now. I
think a mastectomy is almost an outpatient procedure.
Blum: It can be. Well, in those days, the first thing we did was
compare drug use, compare hospital stays, and so on. The deal
we had with Alta Bates was paying them so much a day, in the
hospital. It had nothing to do with how long you stayed, they
301
got paid for each day. Now it hardly works that way. Usually,
the hospital gets paid per case, and the shorter the stay, the
happier everybody is; but Medicare really started that. But if
physicians aren't watchful, or don't give a damn, they
authorize a day more, and in HEALS" time, you start looking at
more days and days, more drugs and drugs, more procedures and
procedures. A lot of procedures aren't really necessary.
The HEALS committees always talked great, but they really
didn't do that much. When HEALS was sold to QualMed, I got
sixty-five dollars for my one share. It wasn't one of those
deals where you sold because the directors made great money.
Quite the contrary, we made nothing, but QualMed picked us up
when we were probably losing a half million dollars a year, at
least.
The first year QualMed is supposed to have netted ten
million dollars on the same operation. QualMed took the same
premiums, same docs, same hospitals, same prices, same drugs;
and it turned a ten-million-dollar profit.
Crawford: How?
Blum: It was now a for-profit venture. It had become a for-profit
venture in my time for various reasons; really had no choice,
mostly because it was losing money. QualMed hired three bright
young docs—one for every thirty-five thousand customers (about
a hundred thousand customers) --and they, not the clerks,
scrutinized all transactions that amounted to anything.
Crawford: Smart.
Blum: Well, those three docs cost QualMed half a million dollars
between them a year, and they saved ten million. Just their
presence had already changed the attitude of what doctors were
going to prescribe, because they knew they'd get called if they
were prescribing something or doing a procedure that was
uncalled for.
Crawford: In front of a peer?
Blum: That's right, in front of a hot, young peer, who knew as much
or more than they did, almost for sure. I don't know how
QualMed operated after that, but that's how they started. I
stayed on as a consumer after 1987.
Crawford: The care was good?
302
Blum:
Crawford:
Blum:
Just the same care, same docs, same hospital, same everything,
but the needless crap was gone.
Crawford;
Blum:
Crawford;
Blum:
Crawford;
Blum:
So, all on balance, a success?
But
Totally. I'm sure that QualMed never regretted buying us.
the point I'm making is that no one doctor, from his
standpoint, could see that. What he kept overlooking was,
"Never mind your take-home, you won't have any patients if you
don't have an organization to compete with Kaiser, because
everybody is going to Kaiser." That was the way it was. The
bulk of the patients that weren't county patients were in
Kaiser, that's that. There were a certain number in Medicare,
too, of course, and Medi-Cal, but it was Kaiser. If you let
that go on, you wouldn't have a practice.
Before HEALS started, at that point, many of the docs that
we knew had just left private practice and gone to Kaiser.
Things were that tough. Or, in some cases, had gone to the
county, because there were hard times, and many people didn't
have the wherewithal, so they went to the county as patients.
Well, the doctors had to go somewhere, and they went to county
or they went to Kaiser, where their patients had gone.
It seems that Kaiser has very simplified billing procedures.
When I go to the hospital, you should see the list of crap that
comes out with the charges.
Exactly.
Well, in Kaiser, there's no such nonsense: You're on this ward?
All right, that's worth eight, nine hundred dollars to the
internal Kaiser bookkeeping, but the patient never sees that.
You've been paid for, and you're done. They don't waste their
time or yours getting your money.
That's very streamlined, in that sense.
Very streamlined. So their administration costs are about 3, 4
percent, and everybody else's plan is probably 15 or 20, you
see. That's still true, although other plans are commencing to
catch on. Many have streamlined themselves to the 10 percent
mark. The little HMO that Contra Costa County runs that was
starting when I left—wasn't my doing, but it was a good idea-
runs at 6 or 7 percent.
For instance, our overhead at HEALS was monstrous when we
started--it was 25 percent. Of course, there are still big
303
insurance companies that run that way. They're taking that
money out of it, but the point is that the development of one
ad, or the development of a billing form, if you use it for two
million customers, is a lot cheaper per customer than using it
for twenty thousand. Contra Costa County managed to do it for
twenty thousand persons, and do it almost as cheaply as Kaiser
with thirty times as many subscribers.
Well, in HEALS' first year, we were scared to death--! mean
a 25 percent overhead, but you knew there was no choice. You
had to negotiate with every single employer. You had to go
back and convince them to buy our product, that we were here to
stay. Our doctors and hospitals were known quantities, and
that helped.
And the next year it dropped to about 20 percent, and that
was quite a relief. And then it dropped to about 15 percent,
and then it dropped to about 12. When you got through the
newness and the development, and then, secondly, you spread it
over a hundred thousand customers, not over five thousand, that
downward shift in overhead costs was exciting.
Crawford: I've been reading about Alta Bates' new birthing center. How
did they have the financial resources to develop this?
Blum: Hospitals have lots and lots of money. Money runs through,
runs through. On the other hand, even as they have lots of
money, they could be going broke. Herrick, before they were
partnered with Alta Bates, spent twenty, thirty million
building a new hospital. And Alta Bates proceeded to get
thirty million bucks to do the same sort of thing. They were
just competing with one another for no purpose. Berkeley
needed one of the two, but not both. Well, this is where the
monies go, you see.
Crawford: So they were always competing?
Blum: Not since they merged, no more duplication of facilities and
staffs. When Bob Montgomery left Alta Bates for ten years, he
was followed by people that were unbelievable. I'll never
forget; I had a hand in picking them out. We weren't very
bright.
In 1983, we had a welcoming party for the new
administrator. My wife went with me to the fancy little
soiree, and when we left, she said, "Who was that tall guy?" I
said, "Well, that's the new administrator." She said, "Oh, no,
you couldn't have picked him? You're going to die with that
304
guy." She did personnel work, years ago, of all places, for
Kaiser at Walnut Creek when they were new.
Crawford: Oh, really? For many years?
Blum: Several years; it was a part-time job, no big deal. She's one
of those people who sizes up people. She's always said she
should have been the doctor in the family. She wasn't wrong on
this guy, either. We got the biggest bluffer you ever saw.
Crawford: Had he come from this program?
Blum: No, no, god knows where he came from. He used to say that he
was a minister's son. He'd been trained, though.
But he managed to get rid of that thirty million bucks — or
most of it—without anything to show for it. He was just a big
operator, and he literally almost killed HEALS. Under his
initiative, Alta Bates suddenly decided to take it over and own
it. They came in with some idiotic claim that they owned 87
percent of it, and they were going to start writing the ticket.
This was when it was really growing like mad, and looking very
prosperous .
We added it all up, and the only thing he had overlooked —
and this is this guy's business training—was the fact that the
docs had never been getting their 20 percent, and that means
that they had been investing their 20 percent in the plan, and
their ownership was like 97 percent, if you wanted to get down
to brass tacks. They owned the whole thing, dollar-wise. So
here they were — and their hospital was trying to steal it.
So it came to quite an impasse. We were switching to for-
profit, because if you weren't for-profit, and you needed to
borrow money, you could only go to the bank, or something
comparable, and there's only so much you can borrow at the bank
without being choked to death on 10 percent interest. We
started converting to for-profit so we could sell stock and
raise money that way, and Alta Bates wouldn't let us convert.
Oh, did we have a time with Alta Bates. We hired lawyers, we
did this, we did that, and we finally got out from under their
clutches, and then went independent.
Crawford: What happened to your administrator at HEALS?
Blum: He was bounced out at the same time. It would be hard to
defend him, although I sort of did, because he was just
brilliant about the strategy of the thing— about which way to
turn on the big scene— but internally, he was a poor
305
administrator. So he had to go, and when I was gone that was
the end for him.
Crawford:
Blum:
At one point, he discovered that we were double paying for
x-ray. Every time a patient got x-rayed in Alta Bates, it was
included in the bill as an extra, but then we'd get separate
repeat bills from x-ray. It was a half million dollars per
year, and I don't think it was accidental, because every kind
of problem we had with Alta Bates was always the same way.
Well, the idiotic thing is that Alta Bates has now had to
reproduce HEALS. Alta Bates has a medical group, and they are
back where they were when they had HEALS--they have a similar
kind of organization, but now the doctors are mostly per
capitated.
Oh, they didn't go with HEALS?
No, although Alta Bates was the key force in setting it up,
they tried to steal it, so HEALS went on its own way. We used
Alta Bates as a hospital, but Alta Bates was no longer in
HEALS, to speak of. They may have owned a few shares of stock
because of their original twenty-thousand-dollar investment.
They were pretty horrible to do business with. They, too,
couldn't even realize that if they lost HEALS, they'd lose a
lot of customers to Kaiser.
Well, anyhow, all this you learn, and when you're teaching,
it's nice to know what you're doing.
Crawford: How did this affect your teaching?
Blum: Oh, it was wonderful. You work longer hours, but you're just
picking up all sorts of information all the time, and nobody
else even knows what's going on. Now a lot of people know
those things, but in those days, where were you going to read
about it? Five years later, somebody will write an article on
it, which might or might not be to the point. But you're
really living it.
Of course, we were constantly negotiating with other HMOs,
sharing territory and considering joining forces—so you were
in everybody's backyard, and you knew all the businesses up and
down the whole Bay Area, and there were many HMOs in the Bay
Area.
Crawford: This was the time when they were being established?
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Blum: Being established, yes. If we weren't in them, we were
negotiating with them. If we weren't negotiating with them, we
were surely watching. So we knew all kinds of things. Well, I
thought it was the difference between knowing what you were
teaching and just teaching.
Crawford: You were really training these public policy students, weren't
you?
Blum: Oh, yes, at the same time, and many of them went into these
operations. Part of our training was always something
practical. When I became the professor of health policy--! 'd
been in health planning before the mid-seventies--all the
students had to work in the field while they were going to
school. This was not as an internship—but they had to honest-
to-god pick up a project and run with it as part of class work.
Thanks to Len Duhl, who had a lot of connections in the state
legislature, many of our students worked in Sacramento for the
assembly or the senate or the governor's offices. They were
full-time students, but as part of our course work they were
doing projects for the organization that they were assigned to.
They had fantastic experiences, and many of them ended up
there. Just the other day I saw several who are still there.
This was at the state health department. There were at least
half a dozen at this one meeting. In many cases, their job
resulted from the project that they had worked on as a student.
Every so often the students had to report to their
assembled class. That's how we operated. It would be teams of
two to five people—usually three or four — and they'd work up
there, and divvy up the tasks, and I didn't have that much to
do with it. They did it, and then they'd come back and fill us
in. We would give them two hours to bring us up to date on
where their team was, what they were doing. So all of us
learned all kinds of things about how our state government
operated and what it was up to.
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VIII INTERNATIONAL FIELD SERVICE: 1969-1981
Dr. Hilleboe and the World Health Organization
Crawford: Today we're going to talk about your international work to
date. How did you get started in field work?
Blum: I had had a good experience, because planning was new, and I
was in charge of that program in the School of Public Health
because nobody else knew what to do with it. It was assumed
that anybody in public health knew all about planning--! think
I said that already—and it turned out we didn't know anything
about it. We had only done planning internally inside of
organizations, which is a very simple matter with a set of
objectives, usually mandated in law. When you deal with a
community, whether it be a city or a county or a state or a
country, the objectives commence to be pretty diffuse, and to
plan is no small matter.
Each year, I got out a little textbook. It was
mimeographed and put out by the Western branch of the American
Public Health Association. It was done at cost, so whoever
bought the book paid for whatever it cost—a couple of dollars
--but each year it got bigger and bigger and finally ended up
being my book on health planning. Originally it started out
with a lot of other contributors because I really hadn't had
the breadth before.
By happenstance, there were some real problems at the UCLA
School of Public Health in the late sixties, and the dean there
invited me down to live through the problems with them. We
ended up with a two-day session with a man by the name of
Herman Hilleboe. He was an assistant surgeon general in the
U.S. Public Health Service, and he was supposed to have become
the next surgeon general of the U.S. Public Health Service, if
and when Dewey became president.
308
Crawford:
Blum:
Herman Hilleboe was picked up by Governor Rockefeller and
brought to New York as director of the New York State Health
Department when Dewey fell by the wayside. He was a sharp,
smooth article; a very, very bright person. Lester Breslow--
who was the dean at UCLA--invited me and Herman Hilleboe to
spend a couple of days with him, looking at health planning,
and we just worked from dawn to dusk and argued beyond, and
Herman Hilleboe could never understand what I was doing,
because he'd always been an in-house or administration planner.
He said, "The governor wants this, so you figure out how to
give him this." But the crux of the matter is that useful
health planners don't work that way. They have to figure out
for the governor what it is that the governor should want. If
you're really a health planner, you have to figure out what a
society or a legislature or somebody else needs. You don't
have all the instructions about what you are to do all handed
down. Typically, the state health officer has a job where it's
all written down. He's got to be smart enough to make it
happen. It's quite different to be smart enough to say what
ought to happen in the first place—who's going to make what
laws under what circumstances — that ' s the job for a health
planner. In reality, without recognizing the nature of the
task as being one of health planning, health officers had
always done this, but without benefit of understanding much
about planning as a skill.
Well, Herman Hilleboe could not understand this. He'd been
so busy all his life in the midst of administrative and
organizational planning that he thought that was all there was
to it. Hilleboe was also the key advisor to the director
general of the World Health Organization, although he didn't
work for WHO on a regular basis. He left Los Angeles for
Geneva and his WHO desk when our little meeting was over.
That's unusual, isn't it?
No, there were quite a few such people in the history of the
WHO, but he was the key one in my time.
So when we finished our meeting in Los Angeles, I gave him
a copy of the book. I remember it was a nice persimmon color,
an eight-and-a-half-by-eleven-size paperback. I asked him to
look at it on the plane--"You may finally understand what I'm
trying to say."
Then in a matter of sixty or ninety days, I get a call from
the World Health Organization to please come and do an
Crawford:
Blum:
Crawford:
Blum:
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examination of a program of theirs. It was a special
committee, and we had to publish our recommendations.
What was the program?
It was an epidemiologic program, and it was run by a scientist
who was kind of a maniac, and he kept destroying it. I never
understood why, because it was a potentially wonderful thing.
We tried to change it all around and we did, but they couldn't
make it work with that guy in charge. They had to finally send
him off somewhere and ended the program.
Do you remember his name?
No, it was a nice English name.
Australia or some place.
He was from New Zealand or
So I get this request to be the person who writes up the
f indings--the rapporteur- -meaning you not only participate but
you write up all the conclusions.
Crawford: This was in Rome?
Blum: No, this was in Geneva at WHO headquarters. I got there, this
was 1969, and I discovered that there was a message waiting for
me to please go see Dr. Bennett. I don't know Dr. Bennett, but
the first thing I see on his desk is my persimmon book. It was
hardly used anywhere, just for our own use around here, so I
couldn't believe it.
He came in and said, "You don't remember me? I used to be
a student of yours while you were at Stanford." He said, "I
also worked in your health department. I did an experiment to
see if the hookworm could propagate and infect people down in
the Walnut Creek to San Ramon area."
Then I remembered this kid. He's a tall handsome guy now.
Here he is, at WHO, one of the bright young men there, and he's
got my book. I said, "How did you get this book?" He said,
"Oh, everybody here's got it. You know Herman Hilleboe, Dr.
Hilleboe? Well, when he came here, this summer, to work, this
was on his desk. So everybody here figured we had to get one."
[laughter]
Hilleboe, I'm sure, had never read it. Hilleboe was still
there, too. But it was funny because if Hilleboe did
something, it became sacred at WHO.
Crawford: Everyone had to have your book.
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Blum:
Crawford;
Blum:
Oh, yes--so that's how I got my start with WHO--through
disagreeing with Hilleboe, who then took my book and probably
never looked at it, but left it on his desk.
That was 1970?
Yes, it was about 1970.
friends.
That was Herman Hilleboe. We became
Working with WHO in Sri Lanka; 1970
Blum: Then three or four assignments all occurred at the same time.
I went to Sri Lanka at their request. That was an interesting,
fascinating experience. I got there, I think, six weeks after
Madame Bandaranaike was made prime minister again. It's a
Commonwealth country, an amazing country. They had better
literacy than we do and are educated in the British tradition;
a kind of humanities tradition. They were very expert at
Shakespeare, but what they really needed were some mechanics
and some people who could run and build railroads and dams or
businesses, and they didn't train those kinds of people.
We got there just a few days after a minor revolt that
occurred when Mme. Bandaranaike was again elected prime
minister. It was supposedly brought about by upper-level
college students who saw no jobs ahead of them. Unemployment
was rife, yet the people were 98 or 99 percent literate with a
good humanities-type education.
Everything seemed very peaceful to us but major changes
were introduced: all teaching and transactions were to be done
in either Tamil or Sinhalese. However, the 80 percent dominant
majority was Sinhalese and this upper-class element who made up
most of the country's leadership no longer knew much Sinhalese,
depending entirely on English and were disadvantaged for the
moment. This turned out not to be practical, but it left a
sense of the government attempting to be fair. This also
tended to turn the tide towards the less well-off 17 percent
who were Tamils and knew Tamil as well as English.
Then one afternoon, she changed the money, and you couldn't
get more than something like ninety new dollars for your old
ones if they were not in usual businesses. So if you had a
million dollars at home, all that money was valueless. You
couldn't give it away. Folks that had been hoarding it and
shipping it out of the country were caught flat-footed. There
311
was nothing you could do with the old money—you could paper
the walls. That took a lot of guts.
Then she appointed all the ministers, who were all new when
I got there. The minister of health that I worked for, helping
him plan for his services, was a country general practitioner
in his thirties from Randy. There are wonderful place names in
that country- -K-A-N-D-Y. It's hill country, and an old
Sinhalese stronghold, and very, very beautiful, I must say.
The first thing he asked me to do was lay out a health
sector plan. I said, "I want a meeting with all the other
national department heads or ministers, or the chief officers.
I would like to hear what you people think your country is all
about. I have to get some sense of where people want to go.
I'm willing to give you a sheet with my notions of your
priorities, because I'm reading your papers like mad, but
that's just my opinion of what I read." Then I said I wanted
to get some information on the planning that had been done for
the physical aspects of the country, and the economics of the
country—everything but health. He told me the planning
department of the national government was in the finance
department .
I had just gone to a party the night before; a party in a
neutral zone, a place where the Poles and the Russians and the
Koreans and the Chinese could also meet with all the other
Europeans. I forget whose party it was; maybe Poland's. There
were people there from every country in the world who were
working, developing that poor country.
A Sri Lankan came up and said to me: "I understand that
you're here to help plan for the health sector. Well, I hope
you're not one of those idiots who's going to tell us to build
more beds and more hospitals and train more doctors." I
wasn't, to be sure. He said, "You know, I've made a tour of
our hospitals and looked at the records. Do you know that 50
percent of the cases that are admitted to the two major
hospitals in this country are there because of contagious
disease spread by dirty water? That's inexcusable. Why do we
even need hospitals? Why in the hell don't we clean up the
water? What's a health department for?"
This was a planner from the finance ministry, and so I
realized I wasn't going to have too much trouble with those
people. He made a lot of sense.
So I had an entree as of that party, and then the minister
of health asked me what I wanted to know. I said, "I want
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about twenty items. For example, I want to know what the
picture was for education by the various grades for 1960, what
it is right about now, or what it will be in 1980 and probably
in 1990, because you are getting ready to have one of the
world's largest irrigation projects."
The Mahelevi River was being dammed, and they were going to
irrigate the highlands, and turn it into a Sacramento Valley.
I don't know if it ever happened. I should go back and find
out.
Then I asked for all the water f igures--what proportion of
the people were going to get clean drinking water, what
proportion dirty water; what proportion were going to have
electricity. This is health, you know, it's not just about
building a hospital. I asked about the roads and the
transportation. It was a country with good, very cheap
transportation all over.
Crawford: The English are responsible for that?
Blum: I've never been inclined to give the British too much credit
for anything because of the disastrous things they've done, but
I guess so. You could say so. Even the big buses around town
were all two-deckers that couldn't be used anymore in England,
but a Sri Lankan can fix anything. It's another one of those
countries with so-called backward people that can do all kinds
of things if they are allowed to.
I found out what proportion of the people would be working
in agriculture, what proportion in other fields. You get down
to the basics of who is going to be healthy if you start
unraveling these questions.
I was invited over to the finance ministry, and they sat me
down in an auditorium, and they said, "Okay, the first thing
you want to know is about water." That's the one that scared
me the most, because that could really wipe the country out
with dirty water which would be provided for the expected huge
population coming into the areas to be irrigated from the new
dam.
They pulled this big chart across the stage. It had a wood
frame, and it was about eight feet high, and eight feet wide.
Here were the charts of water, and the proportions of people
and usage—the things I'd asked for, they already had it worked
out.
Crawford: So they knew about the problem, and they had even analyzed it?
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Blum: Even analyzed it.
Crawford: There must have been lots of development money at that time.
Blum: Oh, yes, there was plenty. Well, then they pulled out another
chart on population, and all by province, so that we could tell
who was going to lose population, because many people would
leave to go to this newly irrigated area in the highlands.
Of course, the reason the highlands were not really already
inhabited was the historical reality of prior irrigation from
huge tanks which were hand-built lakes for irrigation. They
had already irrigated this land a thousand years and more ago,
and had to abandon it because malaria got so bad. This high
country is three, four thousand feet up, and they could grow
everything there, and the heat wasn't so terrific as in the
lower altitude. It could grow many of the crops we produce in
our Central Valley: they could have raised fruits and all kinds
of things like we do here, and that's what they wanted to do.
So I couldn't believe my eyes as to what I was seeing,
because the finance ministry had anything and everything I
wanted, and a hundred things more that I didn't want. We got
it all down in chart form; I handed it over to the minister of
health, who was the kind of man that worked about twenty hours
a day. It was not what you would imagine from a nice, sleepy,
supposedly tropical country. He was a brilliant fellow.
Crawford: Who was he?
Blum: Weratunga, Dr. Weratunga. He was something else--a family
practitioner. He took one look at these figures, and he said,
"My god, we're going to have more people in the hospital than
we have ever had. All this dirty water, and they're all going
to be drinking it? Something's got to be done."
You see, there were economists doing the planning, and they
didn't know or give a damn about health. The health department
wasn't doing anything; he'd just inherited the job. He looked
at the projections and saw unmitigated disaster for the whole
country. The finance guy I had met at the party had seen that
already. There were already hospitals full of contagious
diseases .
Crawford: What were they getting?
Blum: Well, typhoid, particularly, and dysentery.
Crawford: They had not had any typhoid prevention?
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Blum: Not really, untreated water keeps it going, and typhoid
immunization is essentially ineffective. Then, when I started
visiting the hospitals, I discovered that many of them were
reinfecting the patients. They'd come in for one thing and
they'd go out with something else. They didn't have clean
water in many hospitals.
So I went back to the finance department, and they said,
"Those miserable bastards." That's what they called them.
"They won't even plan for building a water system for each
hospital. We have been on their trail for years to at least
have clean water in the hospitals." The money was all set
aside. "They won't use it. They're all for great new
inventions and great new doctoring and they send out people
sick." It was really scandalous.
Well, then I walked into the middle of some interesting
planning. The Health Ministry, further on down the ranks, were
not aware of their incompetence. For example, the hospital
people in Colombo wanted to import a German laundry; the washer
people—there ' s a word for them, dhobies--were all out in the
little ditches and creeks, which are potentially full of
sewage, doing the laundry. But the truth of the matter is if
it looked clean, they'd just fold it up and send it back. All
of this was unsupervised. You pay so many cents per sheet or
per towel or whatever it is, and it all comes back to the
hospital potentially contaminated-- just horrible. But what the
hospital wanted to do was import the world's finest laundry.
I really learned a lot about planning in Sri Lanka. They
had wonderful planners there, and the upper echelons of
government were pretty savvy, too. They had a scheme they
called shadow budgeting, and anything they held really dear was
given new values. They wanted money for foreign trade, and if
your department could save on that, whatever it is that you
wanted to do, the cost was cut on your shadow budget according
to how much foreign exchange you were saving.
For instance, instead of a foreign-built laundry, I figured
out, in a few minutes, what they could do for the dhobies, the
washer people. They could have built a roof over their heads
and could have pumped in clean water—there was clean water in
their hospital so they didn't have to use the ditch water to
wash things with. They could have a supervisor there and use
Clorox/chlorine to sterilize all the laundry; they could have
had a first-class hand laundry.
Well, the shadow budget took into account such things as
the cost for the German machine, about half a million dollars,
315
not counting the near impossibility of ever getting it fixed
once it breaks.
But if you used dhobies, you got no cost shown on your
budget for laundry. You got that free because it was a largely
unemployed group and any budget helping their unemployment got
credit for that. You could launder the sheets for a fraction
of the cost by using hand labor, and the government wanted to
employ those essentially unskilled people, so your budget costs
were nil.
The budget—the country's budget—was built that way. If
you had to buy a foreign thing, you got charged double or
triple because you were using up foreign exchange. If you did
something that was wanted, like employing the unskilled, it was
a freebie on your shadow budget.
This was brilliant, this shadow budget. You want
something—you make it feasible. You don't pay for your
laundry if you can use the dhobies to do it, but if you want
the German machine--. The money came out of the finance
department. You could be taking care of the poor, giving them
jobs, yet this health ministry was blindly working in the
opposite direction. They were going to take the jobs away from
the dhobi and send the money to Germany, and use up foreign
exchange.
So on that basis, the health department was persona non
grata in the finance department- -they were looked upon as
abysmal idiots. The sheets would cost ten cents apiece with a
German laundry, and if you had the dhobies do them, they would
cost a tenth as much. The fact that the government was using
their own valued principles to juggle the budget was wonderful.
It's a rare country that does that in a meaningful way.
It was magnificent planning. Then it turned out, of
course, that there were big budgets for clean water in the
hospitals that were never used. This health director was
appointed just as I got there, and he was losing his mind over
this, because he could see all this horrible stuff going on,
and he was stuck with all these fine old employees who did as
little as possible and never cared. It was a really crummy
system of management for a remarkably equitable service that
covered all persons in the country.
The finance department had an input /output measurement of
everything that was made in the country or brought in, and
where it went, what it was used for. I don't know if there's
another country in the world that really has that. But I went
316
Crawford:
Blum:
Crawford:
Blum:
to the library in the Department of Finance, and I discovered
that the Colombo hospital could have the chlorine for its
laundry essentially for free, because industry in Sri Lanka was
decomposing sea water—the salt part — into sodium, which they
wanted for something, and the chlorine they had to dump back
out in the ocean. So it could have been used for free if the
health department wished to disinfect the hospital laundry
while it was being done by the dhobies.
Well, this is what planners do, and finally 1 had my
meeting with all the ministry people.
I read that there were members of parliament at this conference
in Sri Lanka.
Yes, high level people. I handed them twenty-five or thirty
highly desired national objectives that I had culled out of the
newspapers, and one of them was productivity. That was number
one, as far as I could remember, and number two was something
else. Number three was respect or care for the elderly, and so
on.
I asked them about the list, throwing it out as what the
foreigner would see in the newspapers as national goals.
"These are the things you care about. How about it?" They
said, "Yes, yes, that's a good list."
I said, "There are some problems here with this list. If I
plan for the health sector, and if we hold the care for the
elderly up there very high, as you do, there's not going to be
as much money for the productivity goal. The productivity
sector includes people of different ages, and the money has got
to be spent in different ways for different things, for folks
in the productive age. How do you feel about that?" Here you
have two values, and they're competing with one another.
That's typical of all countries and how their values affect
planning.
They decided that the elderly would come first. Principles
are principles, but values are values, and for them, these came
first. We went through the list, and a lot of concerns shook
out. It was fun. At least you got a feel that they were
responding. I'm planning for them, but am I going to plan for
productivity or going to plan for the elderly? They had to
make decisions relevant to their value schema.
You only have so much?
A country has only so many available resources.
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Crawford:
Blum:
Crawford:
Blum:
Crawford:
Blum:
It was an interesting, rather equitable country. At that
time, everybody got a weekly rice ration. It's the only
country in the world that's ever done that, as far as I know,
and it bankrupted them. They had to give it up.
They got into lots of problems over it--it is not a
communist country; not a socialist country—they just felt very
strongly about how things should be. You say, "Why don't you
just give it to the poor?" They say, "Then we'd have to pick
out the poor, and make them feel poor." The whole business of
putting the finger on people for some demeaning reason was
unacceptable.
Discriminating.
Discriminating, yes. I was very impressed with this, yet saw
that it was high-level politics that had been costing the
country a bundle of money that was not there to be spent.
They had kind of overdone the health sector that way, too.
They had promised everybody health services, so that for the
average person it was available within minutes all over the
country. They had equally invested in the educational sector
and in transportation.
It was a real priority. Is it still?
I can't tell you. I don't know. I suspect it is. There are
things that you can't give up that easily, as Mrs. Margaret
Thatcher found out. But one of the crazy things is that they
had so much respect for individuals that they had two systems:
the ayurvedic system and the Western system of medical care.
Everybody had a choice or could use both. You go anywhere in
the country and you come to a free health station, and there
would be the Western or the ayurvedic--rarely together, though
--they were usually separate.
What is the ayurvedic system?
So
It came from India. It was longstanding—is still there,
there was the free government program and a private pay
program, so, potentially, in any one neighborhood, you had four
kinds of practitioners — a public and a private practitioner in
both Western and ayurvedic medicine.
It was a needlessly expensive system. I visited Western-
type clinics with three or four young docs with nothing to do-
maybe an occasional delivery. Well, that's insanity. You
wreck the doctors because they're not doing anything. You make
318
them kind of unruly because they're feeling neglected and
wasted.
II
Blum: And why should people stop locally for care? For three cents
they can go down to Colombo to the medical school where there
is a big hospital, fancy docs, the works. Besides, they get to
visit and shop in Colombo. The care costs them nothing there
and it costs them nothing here.
A planner should take many things into account: how good
and how cheap the transportation is becomes a factor in health
care, because folks are, if they're human beings, going to go
downtown if the fare is three cents and get their medical care,
even as they continue to live out of town. Well, this is what
planning is all about, you see.
Crawford: You really have to know that culture.
Blum: You've got to know the culture, the practices; you've got to
know the country. Then you have to explain it to the
officialdom and the legislators, so they can make the right
policies .
So here was the country being undermined by a very generous
set of policies—very generous. And a good education--
everybody got educated better there than is the case here.
I sat in on a couple of Commonwealth academic examining
boards. One was the architectural board, whose members come
from Britain and hold the exams for the graduating class.
There's nothing shaky about architecture in Britain, and the
same way of examining goes on in medicine. This is the
valuable aspect of being an active Commonwealth country and
this is reproducing Europe abroad. However, it has no respect
for the native culture, or for the nation's needs. This is the
sad part, you see. They could go all through the medical care
examinations or architecture and never notice that the patients
in the hospitals were there for contagious diseases that never
should have been, and that many hospitals did not provide
potable water to their patients.
By contrast, seven years later, I was wandering through
China, and I went to visit a large hospital in Shanghai. The
pediatrics ward was essentially empty. We asked, "Where are
your patients?" They said, "Well, we don't really have many
children patients — they 're immunized for this, and this, and
this." They're better immunized than our children are. That
319
was true then; I doubt if it's true now. It's slipping now,
they're becoming more like us in their quest for a market
society.
They said, "What we have here are some thyroid problems, we
have some tumors, we have this and that, but it doesn't keep
the wards full anymore. We don't have diphtheria, we don't
have tetanus, we don't have whooping cough or measles. We just
don't have the things that used to fill the hospitals up."
This was looking at the origins of illness in China.
There, in Sri Lanka, they were just building beds and training
M.D. 's.
Crawford: What happened? Did they take notice of your findings?
were there for about three months?
You
Blum:
Crawford:
Blum:
I don't know. I don't think so. Yes, three. I don't think
anything happened at all. While I was there they gave up on
mosquito control, and they had the most horrible outbreak of
malaria the next year. They weren't really listening to
anybody. This was WHO sending a planner. If I'd have stayed
with the health ministry—but you've got to be there for a
couple of years to have an impact,
in and leave a plan.
There's no way you can come
Were you impressed with any of the other development efforts
that were going on?
The planning effort, which was interesting, had been instituted
by a queer combination. An Israeli and an Egyptian set up all
that wonderful planning that I described for the finance
department, but at that point, the Sri Lankans kicked out the
Israelis .
I, it so happened, had come into the country with some
Egyptians, and was actually in the Egyptian enclave. They knew
perfectly well that I was Jewish, but I spent much of my spare
time with the Egyptians, and the man that I was with was the
equivalent of the ambassador. He was the head of the trade
mission there.
He told me a sad story: "You know, all the Israelis are
kicked out, and the other day I saw this ad in the paper for
some second-hand furniture being sold from a home." He said,
"I went out there to see it, and it was just what I wanted. It
turned out it was the Israeli planning director's home, and did
I ever feel awful to even be seen in a situation like that.
This Israeli is kicked out of the country, so here this
320
Egyptian comes in and takes all of his furniture,
couldn't get out of there fast enough."
Horrible. I
These were very alert Egyptians, and it startled me--how
similar they were to Jews. They were cultured in the same way,
interested in the arts, social justice, and the whole shebang.
I fitted right in with them. I don't believe that ever before
or since have I really become that close to people in such a
short time. We actually were all in tears when we left. They
got us a place to live in and did everything for us. I suppose
we were near-alikes in a foreign culture.
Crawford: Your wife went, as well?
Blum: Oh, yes. I never go anywhere without her.
Crawford: You said, last time when we talked, that there was quite a bit
of fraud—if not fraud, you found a lot of obstacles on these
assignments?
Blum: Oh, yes, this one wasn't particularly fraud. It was an old way
of doing business that nobody ever looked at. Some people
never did a day's work, but that was typical not just of that
country, but of many countries including this one. There you
were up against long-standing things, and if you got hired for
three months, you knew there was no serious intent for you to
make significant change.
Crawford: Really?
Blum: How could there be? You're talking about undoing hundreds of
years of the ways a culture operates to produce good education,
good transport.
Crawford: Did they tie you up with a counterpart in the field?
Blum: Yes, there was a chief of planning for the health ministry, and
he was assigned to planning because he was the worst medical
officer they had; they just couldn't find a worse one. So I
had him as my counterpart. He didn't know what we were doing,
he didn't care, he never came to work—he was a total bum. So
they unloaded him on me because they didn't want him in surgery
or obstetrics.
Crawford: What could the government of Sri Lanka hope for?
Blum: Well, I don't know what they expected of me. These are always
the great mysteries. Maybe they could get somebody to do
something they wanted.
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Weratunga probably went to work on that potential dirty
water catastrophe; he was no slouch, but he ended up, in short
order, leaving the ministry. He became the ambassador to
Russia. He was a very, very impressive man.
He was a Sinhalese. The other really impressive man I met
was a Tamil, the dean of the medical school in Kandy. That was
the new school. He was also their representative to WHO--a man
who was on the go. He died of a heart attack as a young man.
He was a perfectionist, and he pushed the country into
creating a formulary or list of the kinds of drugs that would
be allowed into the country and made available. In contrast to
most free-market countries, you couldn't just ship any old
drugs into Sri Lanka--he managed to sell this idea of "useful"
drugs. So they had perhaps a hundred useful drugs imported,
and other than that—no. The manufacturers had to meet a sort
of price guide and everything. It was a beautiful job.
There are almost no other countries like that—Nordics
excepted, but it's not anything I'm used to, for the most part.
He happened to be an M.D., and a pharmacologist, and the dean
of a medical school— wonderful man.
I remember we went to visit his home, up in Kandy, a
beautiful home in beautiful country: everything's green and
there are all kinds of trees, and the climate is such that you
have tropical and nontropical weather.
I said to him— he hadn't been dean too long— "How did you
get such a beautiful home." He said, "I was lucky. I was very
lucky. The man who used to have this home was a professor
here," he said. It's the kind of place where the grounds come
right up to the door, and you walk right into the house— there
are no barriers, you know. He said the professor came in and
went to get one of his favorite books and he pulled out a viper
along with it." It was just a small thing, but it was
poisonous— they ' re widespread. We even saw them on a cruise in
the Greek Islands.
"He went off running," he said, "and he's never been seen
since. He left the country. So his house was standing here,
and I took it." [laughter]
After I'd been there, a Sri Lankan came to visit us here,
and we took him to dinner in the city. I mentioned this tale
about the snake- -he also lived in Kandy, he was from the
university there— and he got quite upset with me for being
derisive about living with all these poisonous snakes. He
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Crawford:
said, "We have a home in Kandy, and I have little children, and
my daughter has a pet cobra out in the backyard. You just
don't interfere with them. It's part of living there." So you
get another side of how people live.
One night in Colombo, we went to visit some Canadians
stationed there, and were living in a magnificent home. They
had beautiful furniture-- just exquisite, a lot of rich woods
and things. Then these smooth floors and giant doors, maybe
fifteen feet across, which slide open, and the house is open to
the yard.
Under every seat at this dinner were mosquito coils and
they were all stinking away so that the smoke was drifting
around and thus the mosquitos wouldn't eat you. There were
three or four significant diseases that they carried there.
The hostess said, "Out there in the backyard"--which is
just behind where Marian and I are sitting—she said, "the
little neighborhood girl came over and was looking at the plum
tree. As she was taking a plum she saw this giant cobra. She
came running into the house to tell me that we had this giant
cobra in our backyard."
So, Marian and I were sitting over a mosquito coil, and of
course it's getting dark. It is dark—in the tropics it gets
dark fast. We spent the evening hoping that those people
facing the yard will see anything out in the yard headed our
way, because we can't. [laughs]
Did you feel badly that the result of your work was less than
dramatic?
Blum: I couldn't. I don't think you're ever asked to take that to
heart. In fact, you're encouraged to be relaxed about it--just
like medical care--you can't take every patient too much to
heart or you'll lose your mind.
Crawford: Did WHO do follow-ups?
Blum: I haven't the faintest idea. I doubt it. The WHO regional
director general was a Sri Lankan. He was a useless bum.
Nobody had any respect for him, at all. He was the big boss
for WHO for the whole region—that part of the world.
It's an interesting thing: the director general in Geneva
does not select the assistant director generals for the
regions. They are voted upon by the countries in the region.
So you get what you get, and that's that.
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The director generals, who for the most part had been very
remarkable people, I think, were not necessarily well-
represented out there in the country. However, the regional
director was very close to everything we did. He was always
home, and since he never did anything, I don't think he cared
whether we ever did anything.
Blum: I believe that Sri Lanka fascinated me for several quite
different reasons. It was the tropics with a discrete society
for 2,000 or more years under three European colonial
dynasties. It emerged with an educated, proud people, well
grounded in humane practices, ahead of us in many ways. But in
retrospect it makes me ill to see how they destroyed themselves
with essentially no outside help in some twenty-five years.
The Sinhalese, 80 percent of the population, came from
northwest India about 2,000 years ago. They are a tall,
handsome, fairly light-skinned people who were never fully
conquered and are proud of their heritage. The Tamils, a
smaller, very dark-skinned group, came about 150 years ago from
the neighboring Indian province, primarily to work in the
British tea plantations in the highlands. They ended up being
to the Sinhalese what blacks are to whites in the U.S.
When I was there, a very elaborate national birth control
program was abandoned because the Sinhalese claimed that it was
going to be genocide for them, the 80 percent majority, because
the poor Tamils who made up 17 percent of the population
wouldn't use birth control. They also felt that the Tamils
weren't worthy people, primarily because they worked too hard.
A minority is apparently always a minority for some so-
called good reason. Discrimination was widespread, and the
Tamils simply revolted, wanting a piece of the country for
their own. The resulting civil war has shown just how
determined the Tamils can be, and everything in Sri Lanka is a
mess. Planning seems to be pointless in the pressure of deep-
seated prejudices. These are lovely people, proud, self-
sufficient, yet being wasted by their own unharnessable
prejudices.
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WHO and a Planning Handbook
Blum: Also in 1970 I was asked to prepare a draft "on how to plan for
health" for WHO. I had a few months to prepare it and then
came to Geneva to present it to an international committee
whose members would critique it for several days, after which I
would take it home to rewrite it, and it would (and did) become
the official guide of WHO on how to plan for health.
WHO's central offices in Geneva are an impressive sight,
and the meeting chambers are truly elegant and functional.
Each speaker is simultaneously translated into English, French,
Russian, and Spanish, and into other languages when
participants require it.
We worked for two hours at a stretch four times a day,
after getting a sendoff by a WHO spokesperson and by whomever
was appointed as the chair for the task.
Criticisms were generally given in a polite but
understandable way by the participants. Early in the first day
I received a rather significant criticism by a well-known
Hungarian planner. Unfortunately, he had found a very weak
spot in my writing that was contradicted by my main thesis.
Almost immediately I found myself being defended by various
members from the Western bloc because the critic was part of
the Russian bloc. I noted his comments and made use of them,
but it was clear that my supporters were less interested in the
significance of the criticisms than in their source.
That evening I was rounded up for dinner by the Western
bloc folks in a session free of any Russian bloc people. This
made the job a lot easier, but probably a bit less rigorous.
During the three working days, the Russian representative,
who was a huge, dour, handsome man in charge of training all
health planners in Russia, and was, 1 was told, the surgeon
general of the Russian army in World War II only spoke
occasionally. His contribution was usually translated into the
same message: "Gentlemen, let us not be so didactic, there is
no one right way to do things. In my own country we just can't
use one way of planning for anything." I found this very
refreshing and wise, and took heed in my rewrite. But
interestingly enough, our Western bloc dinner group concluded
that the Russian was so dogmatic and could only see things in
one light. True, his little speeches were very similar to one
another, but their intent was obviously to get away from hard
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and fast planning rules that would probably be destructive much
of the time if applied.
I learned that Russia was training several thousand health
planners every year; knowing that they did make big top-down
plans, I wondered where all the planners could be utilized. At
a morning tea I asked the Russian translator to ask the Russian
on our committee what they did with so many planners. Without
turning to look at me or skip a sip of tea, the Russian planner
said, "Tell him I'll loan him a thousand planners any time he
wants them." This more than confirmed my guess that they had
gone overboard on turning out planners and that the head of
Russian health planner training was all too aware of that
reality.
These were educational events for me and 1 had the good
fortune to do more such study efforts for WHO in Geneva, in
Copenhagen, in Santiago, in Washington, D.C., in New Orleans,
in Gothenberg, and in The Hague.
At my last such event in The Hague, the participants and
speakers were to be received by Queen Beatrix at a tea on the
last day. I came down with food poisoning and couldn't go, my
wife had to go to uphold our end. The Queen greeted everyone
at the entry to the palace, in their own language. When my
wife was introduced, she immediately commiserated with her
about her sick husband. When the affair broke up, the Queen
sought her out and extended her best wishes. For truly down-
to-earth plebeians as my wife and I both are, this encounter
rather undermined our long-standing antimonarchial biases.
Assignments in South America with the Pan American Health
Organization
Blum: PAHO gave me another assignment, this one a lot more tangible
and highly relevant to their and my own interests. Dr. John
Hastings of the University of Toronto who had carried on a
tremendous study of the desirability and success of combined
human services was my teammate for examining what the merits
might be for the success of combining human services in
Colombia, which had just emerged from its seemingly endless
savageries, and to us outsiders looked as though it were
actively drifting towards perpetual disaster. We met with the
ministers of health and welfare and the dean of the School of
Public Health and some very wealthy and politically powerful
business women and, above all, with liberation theologists who
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were risking their lives to help straighten out the country's
massive injustices. The priests, using their Catholic church's
authority, were espousing the idea of doing God's work in the
here and now, not just in the hereafter--an appealing notion.
We stayed at the exquisite Tecondama Hotel which turned out
to have its problems. One was our experience as the doorman
turned us over to the chauffeur of the Ministry of Health car
taking us to dinner with the minister. The doorman was flanked
in the bustling street-sidewalk mess of a large hotel by two
police armed with submachine guns. In the time it took for us
to cover four feet and get into the car, our chauffeur suddenly
screamed. Someone had stripped off his wristwatch as he was
handing us in with his other arm. From that time on we were
regaled with fearsome tales of how the poor outwitted the more
affluent. Everyone seemed to enjoy recounting the picaresque
doings of the growing class of criminals, who were no longer
necessarily just the poor.
We got to Cali on invitation of the new medical school
there whose dean I had met at a PAHO meeting in the U.S. This
was an interesting city at the center of old estates, large
blocks of undeveloped land being in individual hands, like our
Texas. As we entered town we saw vehicles upside down, on
fire, wheels rotating with tongues of flame. Some young people
and a few troops occasionally appeared. This was the first day
of a strike by students at the medical school, a strike that
spread and finally closed the whole university, a fairly
liberal enclave, for a year and more.
In South America, medical students came primarily from
wealthy families and so a strike, over social causes, is an
interesting situation in which few student strikers were likely
to be hurt.
I was brought to our meeting place, away from campus, and
we had an afternoon presentation by an American systems
theorist. He described his introduction of systemic
relationships to second-year medical students. One issue he
presented to them involved that of the care of numerous babies
near death from starvation who came from the nearby hillside
barrios of Cali. These were families of squatters, mostly
Indian, coming into the city out of desperation, finding a spot
on which to rest, one which had no streets, no utilities, no
buildings, but enough room to start creating something in the
way of a shelter out of tin cans, cardboard, rock, boards, tar
paper, logs, whatever. These